ACUTE RENAL

FAILURE
Acute renal failure (ARF) is a clinical
characterized by an abrupt decline in
glomerular filtration rate (GFR) and the
accumulation of nitrogenous waste (urea
nitrogen and creatinine)
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Prerenal
Hipovolemia
Reduced effective extra cellular volume
Renal Arterial Occlusion
Intrarenal vascular
Vasculitis
Hemolytic uremic syndrome
Trombotic thrombocytopenic purpura
Accelerated hypertension
Glomerulonephritis
Ischemic acute tubular necrosis (ATN)
Toxic ATN
Endogenous toxin
Exogenous toxin
Interstitial
Acute allergic interstitial nephritis
Bilateral acute pyelonephritis
Intrarenal Obstruction
Casts
Crystal's
Renal Vein occlusion
Urinary tract obstruction
Prerenal
Renal
Postrenal
Renal
parenchymal
Causes of prerenal failure
Prerenal failure
Reduced efective
Extracellular fluid volume
Impaired renal
autoregulation
Hypovolemia

Hemorrhage

Fluid loss :
gastrointestinal,
renal, skin,
respiratory,
surgical

Hypoalbuminemia

Third spacing
Cardiac failure

Myocardial dysfunction

Valvular dysfunction

Cardiac tamponade

Pulmonary hypertension
Systemic
Vasodilatation

Sepsis

Cirrhosis

Anaphylaxis

Anesthesia

Pharmacologic
vasodilatation
Preglomerular
vasoconstriction

Sepsis

Hypercalcemia

Hepatorenal syndrome

Pharmacologic agents :
NSAIDs,
Cyclosporin A
Amphotericin B
Epinephrine
norepinephrine
Postglomerular
vasoconstriction

ACE inhibitors

Angiotensin T1
receptor antagonists
Hypovolemia
Decreased effective
Arterial blood volume
Baroreceptor activation
Neurohormonal responses
Renin angiotensin
Aldosteron axis
Vasopressin
Sympathetic
nervous system
Vasoconstriction
Mesangial cell contraction
Avid salt and water reabsorption
Reduce sweating
Thirst and salt appetite
Renal blood flow maintained
Initially through :
Local myenteric reflex
prostaglandin synthesis
actions of angiotensin II
Homeostatic goal :
Restore intravascular volume
And blood pressure to maintain
Perfusion of essential
organs
Prerenal acute renal failure
Dramatic reduction in renal
Blood flow, glomerular filtration,
Urine flow
Dramatic reduction in
Splanchnic, skin, and
Musculoskeletal blood flow