Failure

Acute Prerenal Failure

search

Acute Prerenal Failure, Prerenal Failure, Prerenal Uremia Syndrome, Prerenal Failure Causes

  • See Also
  1. Acute Kidney Injury
  2. Acute Interstitial Nephritis
  3. Acute Postrenal Failure
  4. Medication Causes of Acute Kidney Injury
  5. Acute Kidney Injury Causes
  6. Nephrotoxicity Risk
  7. Intravenous Contrast Related Acute Renal Failure
  8. Chronic Renal Failure
  • Epidemiology
  1. Accounts for 50-70% of all Acute Renal Failure
  • Causes
  • Prerenal Failure (70% of causes)
  1. See Medication Causes of Prerenal Failure
  2. Mechanism: Decreased renal perfusion
    1. Intravascular volume depletion (e.g. Dehydration, third-spacing)
    2. Decreased arterial pressure (e.g. CHF, Sepsis)
  3. Extracellular fluid loss (Volume depletion)
    1. Burn Injury
    2. Diarrhea
    3. Vomiting
    4. Diuresis (e.g. Diuretics, DKA)
    5. Diaphoresis
    6. Hemorrhage (e.g. Trauma, major upper gastrointestinal Hemorrhage)
  4. Extracellular fluid volume sequestration
    1. Pancreatitis
    2. Muscle crush injury
    3. Systemic vasodilation (e.g. Septic Shock, Neurogenic Shock)
  5. Inadequate Cardiac Output
    1. Severe Congestive Heart Failure
    2. Cardiogenic Shock
  6. Intra-Renal Vasoconstriction
    1. See Medication Causes of Prerenal Failure (e.g. ACE Inhibitors, ARBs, NSAIDS)
    2. Cardiorenal Syndrome
    3. Hepatorenal Syndrome
    4. Abdominal Compartment Syndrome
  • Pathophysiology
  1. Reduced Cardiac Output and renal perfusion pressure (shock states)
  2. Results in afferent arteriole constriction
  3. Avid Sodium and Water reabsorption
  4. Oliguria
  5. Acute Tubular Necrosis if prolonged hypoperfusion
  • Signs
  1. Impaired Cardiac Output
    1. Neck vein distention
    2. Rales
    3. Gallup Rhythm
    4. Pedal edema
  2. Orthostatic Blood Pressure and pulse changes
  3. Weight loss
  4. Decreased fluid intake
  5. Decreased Urine Output
  • Differential Diagnosis
  1. See Acute Kidney Injury
  2. See Postrenal Failure
  • Diagnostics
  1. Empiric volume replacement
  2. Invasive cardiac monitoring
  • Labs
  1. See Renal Function
  2. Urine Sediment
    1. Normal sediment
    2. Hyaline Casts
    3. Granular Casts
  • Management
  1. See Acute Kidney Injury Management
  • Prognosis
  1. See Acute Kidney Injury Prognosis
  • Prevention
  1. See Prevention of Kidney Disease Progression
  • Resources
  1. Acute Kidney Injury Guidelines
    1. http://www.renal.org/clinical/guidelinessection/AcuteKidneyInjury.aspx
  • Reference
  1. Anderson (8/15/1993) Hospital Practice, p. 61-75
  2. Meyer (2007) N Engl J Med 357(13): 1316-25 [PubMed]
  3. Rahman (2012) Am Fam Physician 86(7): 631-9 [PubMed]
  4. Singri (2003) JAMA 289(6):747-51 [PubMed]