Prerenal

• Volume depletion
  • Blood loss
  • GI fluid loss (e.g., vomiting, diarrhea)
  • Overzealous diuretic use
• Volume overload with reduced renal perfusion
  • Congestive heart failure
    • Low-output with systolic dysfunction
    • "High-output" (e.g., anemia, thyrotoxicosis)
  • Hepatic cirrhosis
  • Severe hypoproteinemia
• Renovascular disease
• Drugs
  • NSAIDs, cyclosporine, amphotericin B, ACE inhibitors, ARBs
• Other
  • Hypercalcemia, "third spacing" (e.g., pancreatitis, systemic inflammatory response), hepatorenal syndrome

Intrinsic

• Acute tubular necrosis (ATN)
  • Hypotension or shock, prolonged prerenal azotemia, postoperative sepsis syndrome, rhabdomyolysis, hemolysis, drugs
  • Radiocontrast, aminoglycosides, cisplatin
• Other tubulointerstitial disease
  • Allergic interstitial nephritis
  • Pyelonephritis (bilateral, or unilateral in single functional kidney)
  • Heavy metal poisoning
• Atheroembolic disease-after vascular procedures, thrombolysis, or anticoagulation
• Glomerulonephritis
  (1) ANCA-associated: Wegener’s granulomatosis, idiopathic pauci-immune GN, PAN
  (2) Anti-GBM disease; isolated or with pulmonary involvement (Goodpasture’s syndrome)
  (3) Immune complex-mediated
  • Subacute bacterial endocarditis, SLE, cryoglobulinemia (with or without hepatitis C infection), postinfectious GN (classically poststreptococcal)
• IgA nephropathy and Henoch-Schönlein purpura
• Glomerular endotheliopathies
• Thrombotic microangiopathy, malignant hypertension, scleroderma, antiphospholipid syndrome, preeclampsia

Postrenal (Urinary Tract Obstruction)

• Bladder neck obstruction, bladder calculi
• Prostatic hypertrophy
• Ureteral obstruction due to compression
  • Pelvic or abdominal malignancy, retroperitoneal fibrosis
• Nephrolithiasis
• Papillary necrosis with obstruction

Note: NSAIDs, nonsteroidal anti-inflammatory drugs; ACE, angiotensin-converting enzyme; ARBs, angiotensin receptor blockers; ANCA, antineutrophil cytoplasmic antibody; GN, glomerulonephritis; PAN, polyarteritis nodosa; GBM, glomerular basement membrane; SLE, systemic lupus erythematosus.

Chapter:
Acute Renal Failure