Internal Medicine

P1: SBT

0521779407-02 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:18

52 Acute Renal Failure

➣Small, contracted kidneys on ultrasound indicate renal disease

is chronic.

➣If unsure, assume acute.

■Etiology of ARF – Divide into prerenal, intrarenal, postrenal

Prerenal

■Volume depletion

➣Hemorrhage

➣GI losses

➣Renal losses (diuretics)

■Decreased effective circulating volume with increased extracellular

fluid volume (edematous disorders)

➣Decreased cardiac function

➣Systemic vasodilation

Sepsis

Liver failure

Anaphylaxis

■Decreased renal perfusion

➣NSAID (afferent artery constriction)

➣Cyclosporine A

➣ACE-I (efferent artery vasodilation)

Intrarenal

■AT N

➣Hypotension

➣Nephrotoxic drug exposure, poisons

Aminoglycosides

Amphotericin B

Radiocontrast

Rhabdomyolysis (myoglobin)

Cisplatin

Pentamidine

Foscarnet

IVIG

Mannitol

Tenofovir

■Interstitial nephritis

➣NSAID

➣Other drug exposure

■Atheroembolic disease

■Glomerulonephritis/microvascular disease