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ACUTE RENAL FAILURE |
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pre-renal: [= acute reversible renal hypoperfusion; usually gives OLIGURIA] |
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shock (low BP) from any cause vascular disease limiting renal perfusion, e.g. dissecting aortic aneurysm involving renal arteries |
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post-renal: [usually causes ANURIA] |
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obstruction to outflow tract of both kidneys, e.g. prostatism, retroperitoneal fibrosis |
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intrinsic renal disease: [clinical presentation ranges from oliguria to polyuria] |
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acute tubular necrosis: |
ischaemic [commonest cause] |
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nephrotoxicity: |
pigment-induced: rhabdomyolysis with myoglobinuria haemoglobinuria, eg. with massive haemolysis |
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drugs: aminoglycosides radio-contrast media ecstasy |
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organic solvents: carbon tetrachloride |
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acute papillary necrosis (necrotising papillitis): |
acute pyelonephritis in a diabetic chronic analgesic abuse |
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infective: |
leptospirosis haemolytic-uraemic syndrome (E.coli 0157:H7) septicaemia |
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diffuse renal vascular disease: |
polyarteritis nodosa disseminated intravascular coagulation |
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other renal disease: |
rapidly progressive or severe glomerulonephritis renal vein thrombosis (commonest in nephrotic syndrome)acute drug-induced tubulo-interstitial nephritis, e.g. barbiturates and many other drugs |
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other / miscellaneous: |
eclampsia [causing diffuse cortical necrosis]heavy metal poisoning, e.g. mercuryliver disease (hepato-renal syndrome)severe acute hypercalcaemia any acute infection in chronic renal failure |
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NB: causes of oliguria or anuria may overlap or follow each other, e.g. prolonged pre-renal renal failure commonly leads to acute tubular necrosis
| FACTORS PREDISPOSING TO RENAL INJURY INCLUDE: |
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diabetes mellitus hypovolaemia myeloma proteinuria arteriopathy drugs: NSAIDs, ACE inhibitors and angiotensin II receptor blockers |
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