Renal insufficiency
| Renal insufficiency | ||
| ICD-10 | N17-N19 | |
|---|---|---|
| ICD-9 | 584-585 | |
| DiseasesDB | 26060 | |
| MeSH | C12.777.419.780.500 | |
Template:Renal insufficiency Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Renal failure; azotemia; kidney failure; kidney insufficiency
For more detailed information please see the chapters on acute renal failure and chronic renal failure. This chapter is simply an overview of these more specific disease states.
Overview
Classification
Renal failure can broadly be divided into two categories (see flowchart below): acute renal failure and chronic renal failure.
Renal failure classification
| Renal Failure | |||||||||||||||||||
| Chronic | Acute | ||||||||||||||||||
The type of renal failure (acute vs. chronic) is determined by the trend in the serum creatinine. Other factors which may help differentiate acute and chronic renal failure include the presence of anemia and the kidney size on ultrasound. Long-standing, i.e. chronic, renal failure generally leads to anemia and small kidney size.
Acute renal failure
Acute renal failure (ARF) is, as the name implies, a rapidly progressive loss of renal function, generally characterised by oliguria (decreased urine production, quantified as less than 400 mL per day in adults,[1] less than 0.5 mL/kg/h in children or less than 1 mL/kg/h in infants); body water and body fluids disturbances; and electrolyte derangement. An underlying cause must be identified to arrest the progress, and dialysis may be necessary to bridge the time gap required for treating these fundamental causes. ARF can result from a large number of causes.
Chronic renal failure
Chronic renal failure (CRF) can either develop slowly and show few initial symptoms, be the long term result of irreversible acute disease or be part of a disease progression. There are many causes of CRF. The most common cause is diabetes mellitus. End-stage renal failure (ESRF) is the ultimate consequence, in which case dialysis is required unless a donor for a renal transplant is found.
Acute on chronic renal failure
Acute renal failure can be present on top of chronic renal failure. This is called acute-on-chronic renal failure (AoCRF). The acute part of AoCRF may be reversible and the aim of treatment, as with ARF, is to return the patient to their baseline renal function, which is typically measured by serum creatinine. AoCRF, like ARF, can be difficult to distinguish from chronic renal failure, if the patient has not been monitored by a physician and no baseline (i.e., past) blood work is available for comparison.==Causes==
Causes by Organ System
| Cardiovascular | No underlying causes |
| Chemical/Poisoning | No underlying causes |
| Dental | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | Balsalazide, Beractant, Cefadroxil, Ceftazidime, Cladribine, Cytarabine, Dalfampridine, Desogestrel and Ethinyl Estradiol, Dolutegravir, Flurbiprofen, Ixabepilone, Meropenem, Oprelvekin, Oxaprozin, Pamidronic acid, Pegylated interferon alfa-2b, Piperacillin, Ritonavir, Siltuximab, Sorafenib, Suprofen, Tiagabine, Trametinib, Tolmetin |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | No underlying causes |
| Hematologic | No underlying causes |
| Iatrogenic | No underlying causes |
| Infectious Disease | No underlying causes |
| Musculoskeletal/Orthopedic | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional/Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | No underlying causes |
| Ophthalmologic | No underlying causes |
| Overdose/Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | No underlying causes |
| Renal/Electrolyte | No underlying causes |
| Rheumatology/Immunology/Allergy | No underlying causes |
| Sexual | No underlying causes |
| Trauma | No underlying causes |
| Urologic | No underlying causes |
| Miscellaneous | No underlying causes |
Causes in Alphabetical Order
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References
- ↑ Klahr S, Miller S (1998). "Acute oliguria". N Engl J Med. 338 (10): 671–5. PMID 9486997. Free Full Text.