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Pathology - Acute renal failure
Definition: Significant deterioration in renal function over hours or days.
Epidemiology • Common. • This condition is typically a complication of a pre-existing sickness that disrupts circulation.
Aetiology • Hypoperfusion, such as hypovolaemia or sepsis, occurs prior to renal function.
• Renal ('intrinsic'): acute tubular injury, drug-induced interstitial nephritis, anti-glomerular basement membrane disease, small vessel vasculitis, hemolytic uraemic syndrome (HUS), thrombotic thrombocytopenic purpura (TTP) and severe hypertension.
• Post-renal: bilateral obstruction (or obstruction of a single kidney). 2 The most prevalent causes are hypoperfusion and acute tubular damage.
Pathogenesis: • Kidney disease causes sudden decline in function.
Presentation: • Oliguria (passing little amounts of urine) is the most common symptom, but some cases may show no symptoms. • Severe cases result in pulmonary edema, encephalopathy, and pericarditis.
Biochemistry: Serum urea and creatinine are key indicators. • Hyperkalemia and metabolic acidosis are also prevalent. Severe hyperkalemia is pro-arrhythmic and can cause cardiac arrest, requiring rapid treatment. Prognosis • Pre-renal and post-renal acute renal failure (ARF) can be reversible if promptly addressed by restoring circulation volume or alleviating obstruction. • Intrinsic types of ARF typically necessitate dialysis while the underlying etiology is managed and renal function recuperates.
Definition: Significant deterioration in renal function over hours or days.
Epidemiology • Common. • This condition is typically a complication of a pre-existing sickness that disrupts circulation.
Aetiology • Hypoperfusion, such as hypovolaemia or sepsis, occurs prior to renal function.
• Renal ('intrinsic'): acute tubular injury, drug-induced interstitial nephritis, anti-glomerular basement membrane disease, small vessel vasculitis, hemolytic uraemic syndrome (HUS), thrombotic thrombocytopenic purpura (TTP) and severe hypertension.
• Post-renal: bilateral obstruction (or obstruction of a single kidney). 2 The most prevalent causes are hypoperfusion and acute tubular damage.
Pathogenesis: • Kidney disease causes sudden decline in function.
Presentation: • Oliguria (passing little amounts of urine) is the most common symptom, but some cases may show no symptoms. • Severe cases result in pulmonary edema, encephalopathy, and pericarditis.
Biochemistry: Serum urea and creatinine are key indicators. • Hyperkalemia and metabolic acidosis are also prevalent. Severe hyperkalemia is pro-arrhythmic and can cause cardiac arrest, requiring rapid treatment. Prognosis • Pre-renal and post-renal acute renal failure (ARF) can be reversible if promptly addressed by restoring circulation volume or alleviating obstruction. • Intrinsic types of ARF typically necessitate dialysis while the underlying etiology is managed and renal function recuperates.
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