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Symptoms and Signs – Differential Diagnosis of Renal Failure, Prerenal Causes
DECREASED CARDIAC OUTPUT
• Congestive heart failure (CHF)
• Arrhythmias
• Pericardial constriction or tamponade
• Pulmonary embolism
HYPOVOLEMIA
• GI tract loss (vomiting, diarrhea, nasogastric suction)
• Blood losses (trauma, GI tract surgery)
• Renal losses (diuretics, mineralocorticoid deficiency, postobstructive diuresis)
• Skin losses (burns)
VOLUME REDISTRIBUTION
• Decrease in effective blood volume
• Hypoalbuminemic states (cirrhosis, nephrosis)
• Sequestration of fluid in “third” space (ischemic bowel, peritonitis, pancreatitis)
• Peripheral vasodilation (sepsis, vasodilators, anaphylaxis)
ALTERED RENAL VASCULAR RESISTANCE
• Increase in afferent vascular resistance (nonsteroidal anti-inflammatory drugs [NSAIDs], liver disease, sepsis, hypercalcemia, cyclosporine)
• Decrease in efferent arteriolar tone (angiotensin-converting enzyme [ACE] inhibitors)
DECREASED CARDIAC OUTPUT
• Congestive heart failure (CHF)
• Arrhythmias
• Pericardial constriction or tamponade
• Pulmonary embolism
HYPOVOLEMIA
• GI tract loss (vomiting, diarrhea, nasogastric suction)
• Blood losses (trauma, GI tract surgery)
• Renal losses (diuretics, mineralocorticoid deficiency, postobstructive diuresis)
• Skin losses (burns)
VOLUME REDISTRIBUTION
• Decrease in effective blood volume
• Hypoalbuminemic states (cirrhosis, nephrosis)
• Sequestration of fluid in “third” space (ischemic bowel, peritonitis, pancreatitis)
• Peripheral vasodilation (sepsis, vasodilators, anaphylaxis)
ALTERED RENAL VASCULAR RESISTANCE
• Increase in afferent vascular resistance (nonsteroidal anti-inflammatory drugs [NSAIDs], liver disease, sepsis, hypercalcemia, cyclosporine)
• Decrease in efferent arteriolar tone (angiotensin-converting enzyme [ACE] inhibitors)
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