Acute renal failure (ARF) is a rapid loss of renal function due to damage to the kidneys, resulting in retention of nitrogenous (urea and creatinine) and non-nitrogenous waste products that are normally excreted by the kidney. Depending on the severity and duration of the renal dysfunction, this accumulation is accompanied by metabolic disturbances, such as metabolic acidosis (acidification of the blood) and hyperkalaemia (elevated potassium levels), changes in body fluid balance, and effects on many other organ systems. It can be characterised by oliguria or anuria (decrease or cessation of urine production), although nonoliguric ARF may occur. It is a serious disease and treated as a medical emergency. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... In medicine (nephrology) renal function is an indication of the state of the kidney and its role in physiology. ... The kidneys are organs that filter wastes (such as urea) from the blood and excrete them, along with water, as urine. ... Urea is an organic compound with the chemical formula (NH2)2CO. Urea is also known as carbamide, especially in the recommended International Nonproprietary Names (rINN) in use in Europe. ... Creatinine is a breakdown product of creatine phosphate in muscle, and is usually produced at a fairly constant rate by the body (depending on muscle mass). ... In medicine, metabolic acidosis is a state in which the blood pH is low (under 7. ... Hyperkalemia (hyper is high, kalium is the Latin name for potassium) is an elevated blood level (above 5. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... Oliguria and anuria are the decreased or absent production of urine, respectively. ... Oliguria and anuria are the decreased or absent production of urine, respectively. ... {{Otheruses4|the medical term|the Australian television series|Medical Emergenc an immediate threat to a persons life or long term health. ...

Causes

Renal failure, whether chronic or acute, is usually categorised (as in the flowchart below) according to pre-renal, renal and post-renal causes. Renal failure is the condition in which the kidneys fail to function properly. ... Chronic renal failure (CRF, or chronic kidney failure, CKF, or chronic kidney disease, CKD) is a slowly progressive loss of renal function over a period of months or years and defined as an abnormally low glomerular filtration rate, which is usually determined indirectly by the creatinine level in blood serum. ... A simple flowchart for what to do if a lamp doesnt work A flowchart (also spelled flow-chart and flow chart) is a schematic representation of an algorithm or a process. ...

• Pre-renal (causes in the blood supply):
  • hypovolemia (decreased blood volume), usually from shock or dehydration and fluid loss or excessive diuretics use.
  • hepatorenal syndrome in which renal perfusion is compromised in liver failure
  • vascular problems, such as atheroembolic disease and renal vein thrombosis (which can occur as a complication of the nephrotic syndrome)

• Renal (damage to the kidney itself):
  • infection usually sepsis (systemic inflammation due to infection),rarely of the kidney itself, termed pyelonephritis
  • toxins or medication (e.g. some NSAIDs, aminoglycoside antibiotics, iodinated contrast, lithium)
  • rhabdomyolysis (breakdown of muscle tissue) - the resultant release of myoglobin in the blood affects the kidney; it can be caused by injury (especially crush injury and extensive blunt trauma), statins, stimulants and some other drugs
  • hemolysis (breakdown of red blood cells) - the hemoglobin damages the tubules; it may be caused by various conditions such as sickle-cell disease, and lupus erythematosus
  • multiple myeloma, either due to hypercalcemia or "cast nephropathy" (multiple myeloma can also cause chronic renal failure by a different mechanism)
  • acute glomerulonephritis which may due to a variety of causes, such as anti glomerular basement membrane disease/Goodpasture's syndrome, Wegener's granulomatosis or acute lupus nephritis with systemic lupus erythematosus

• Post-renal (obstructive causes in the urinary tract) due to:
  • medication interfering with normal bladder emptying.
  • benign prostatic hypertrophy or prostate cancer.
  • kidney stones.
  • due to abdominal malignancy (e.g. ovarian cancer, colorectal cancer).
  • obstructed urinary catheter.

In physiology and medicine, hypovolemia (also hypovolaemia) is a state of decreased blood volume; more specifically, decrease in volume of blood plasma. ... This article is about the medical condition. ... Dehydration (hypohydration) is the removal of water (hydro in ancient Greek) from an object. ... A diuretic (colloquially called a water pill) is any drug or herb that elevates the rate of bodily urine excretion (diuresis). ... Hepatorenal syndrome (HRS), also called hepatorenal failure, refers to acute renal failure that occurs in the setting of cirrhosis or fulminant liver failure associated with portal hypertension, usually in the absence of other disease of the kidney. ... In physiology, perfusion is the process of nutritive delivery of arterial blood to a capillary bed in the biological tissue. ... Liver failure is the final stage of liver disease. ... Atheroembolic disease is medical conditions caused by the embolization of ruptured atheromatous plaques into distal blood vessels. ... Renal vein thrombosis (RVT) is the formation of a clot or thrombus obstructing the renal vein, leading to a reduction in drainage of the kidney. ... An infection is the detrimental colonization of a host organism by a foreign species. ... Sepsis (in Greek Σήψις, putrefaction) is a serious medical condition, resulting from the immune response to a severe infection. ... Pyelonephritis is an ascending urinary tract infection that has reached the pyelum (pelvis) of the kidney (nephros in Greek). ... This article or section does not cite any references or sources. ... This article does not cite any references or sources. ... Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic and anti-inflammatory effects - they reduce pain, fever and inflammation. ... Aminoglycosides are a group of antibiotics that are effective against certain types of bacteria. ... iodinated contrast is an intervenous radiographic die containing iodine, which enhances vascular structures and organs. ... Lithium salts are chemical salts of lithium used primarily in the treatment of bipolar disorder as mood stabilizing drugs. ... Rhabdomyolysis is the breakdown of skeletal muscle due to injury, either mechanical, physical or chemical. ... An X-ray diffraction image for the protein myoglobin. ... This article does not cite any references or sources. ... Lovastatin, the first statin to be marketed The statins (or HMG-CoA reductase inhibitors) form a class of hypolipidemic agents, used as pharmaceutical agents to lower cholesterol levels in people with or at risk for cardiovascular disease. ... Stimulants are drugs that temporarily increase alertness and wakefulness. ... Hemolysis (alternative spelling haemolysis) literally means the excessive breakdown of red blood cells. ... “Red cell” redirects here. ... Structure of hemoglobin. ... Sickle-cell disease is a group of genetic disorders caused by sickle hemoglobin (Hgb S or Hb S). ... Multiple myeloma (also known as MM, myeloma, plasma cell myeloma, or as Kahlers disease after Otto Kahler) is a type of cancer of plasma cells which are immune system cells in bone marrow that produce antibodies. ... Hypercalcaemia is an elevated calcium level in the blood. ... Glomerulonephritis is a primary or secondary autoimmune renal disease featuring inflammation of the glomeruli. ... Goodpasture’s syndrome (also known as Goodpasture’s disease and anti-glomerular basement membrane disease or anti-GBM disease) was first described by Ernest Goodpasture in 1919. ... In medicine (rheumatology), Wegeners granulomatosis is a form of vasculitis that affects the lungs, kidneys and other organs. ... This article does not cite any references or sources. ... Benign prostatic hyperplasia (BPH) is the increase in size of the prostate in middle_aged and elderly men. ... Prostate cancer is a disease in which cancer develops in the prostate, a gland in the male reproductive system. ... Kidney stones are solid accretions (crystals) of dissolved minerals in urine found inside the kidneys or ureters. ... Ovarian cancer is a malignant tumor (a kind of neoplasm) located on an ovary. ... Colorectal cancer, also called colon cancer or bowel cancer, includes cancerous growths in the colon, rectum and appendix. ... In urinary catheterization, a urinary catheter, (such as a Foley catheter) is a slender plastic tube which is inserted through a patients urinary tract into their bladder. ...

Diagnosis

Renal failure is generally diagnosed either when creatinine or blood urea nitrogen tests are markedly elevated in an ill patient, especially when oliguria is present. Previous measurements of renal function may offer comparison, which is especially important if a patient is known to have chronic renal failure as well. If the cause is not apparent, a large amount of blood tests and examination of a urine specimen is typically performed to elucidate the cause of acute renal failure, medical ultrasonography of the renal tract is essential to rule out obstruction of the urinary tract. Creatinine is a breakdown product of creatine phosphate in muscle, and is usually produced at a fairly constant rate by the body (depending on muscle mass). ... The blood urea nitrogen (BUN) test is a measure of the amount of nitrogen in the blood that comes from urea. ... Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ... This article or section is in need of attention from an expert on the subject. ... Medical ultrasonography (sonography) is an ultrasound-based diagnostic imaging technique used to visualize muscles and internal organs, their size, structures and possible pathologies or lesions. ...

Consensus criteria^[1][2] for the diagnosis of ARF are:

• Risk: serum creatinine increased 1.5 times OR urine production of <0.5 ml/kg body weight for 6 hours
• Injury: creatinine 2.0 times OR urine production <0.5 ml/kg for 12 h
• Failure: creatinine 3.0 times OR creatinine >355 μmol/l (with a rise of >44) or urine output below 0.3 ml/kg for 24 h
• Loss: persistent ARF for more than four weeks complete loss of kidney function

Kidney biopsy may be performed in the setting of acute renal failure, to provide a definitive diagnosis and sometimes an idea of the prognosis, unless the cause is clear and appropriate screening investigations are reassuringly negative. Brain biopsy A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... Prognosis (older Greek πρόγνωσις, modern Greek πρόγνωση - literally fore-knowing, foreseeing) is a medical term denoting the doctors prediction of how a patients disease will progress, and whether there is chance of recovery. ...

Treatment

Acute renal failure may be reversible if treated promptly and appropriately. The main interventions are monitoring fluid intake and output as closely as possible; insertion of a urinary catheter is useful for monitoring urine output as well as relieving possible bladder outlet obstruction, such as with an enlarged prostate. In the absence of fluid overload, administering intravenous fluids is typically the first step to improve renal function. Fluid administration may be monitored with the use of a central venous catheter to avoid over or under replacement of fluid. If the cause is obstruction of the urinary tract, relief of the obstruction (with a nephrostomy or urinary catheter) may be necessary. Metabolic acidosis and hyperkalemia, the two most serious biochemical manifestations of acute renal failure, may require medical treatment with sodium bicarbonate administration and antihyperkalemic measures, unless dialysis is required. In urinary catheterization, a urinary catheter, like foley catheter, a slender plastic tube, is pushed up a patients urinary tract into their bladder. ... An intravenous drip in a hospital Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ... In medicine, a central venous catheter (CVC or central venous line) is a catheter placed into a large vein in the neck, chest or groin, this is inserted by a physician when the patient needs more intensive cardiovascular monitoring, for assessment of fluid status, and for increased viability of intravenous... A nephrostomy is an artificial opening created between the kidney and the skin which allows for the drainage of urine directly from the upper part of the urinary system (renal pelvis). ... In urinary catheterization, a urinary catheter, (such as a Foley catheter) is a slender plastic tube which is inserted through a patients urinary tract into their bladder. ... In medicine, metabolic acidosis is a state in which the blood pH is low (under 7. ... Hyperkalemia is an elevated blood level (above 5. ... Sodium bicarbonate is the chemical compound with the formula NaHCO3. ... In medicine, dialysis is a type of renal replacement therapy which is used to provide an artificial replacement for lost kidney function due to renal failure. ...

Should hypotension prove a persistent problem in the fluid replete patient, dopamine or other inotropes may be given to improve cardiac output and renal perfusion. A Swan-Ganz catheter may be used, to measure pulmonary artery occlusion pressure to provide a guide to left atrial pressure (and thus left heart function) as a target for inotropic support. Dopamine is a phenethylamine naturally produced by the human body. ... An inotrope is an agent which increases or decreases the force or energy of muscular contractions. ... Cardiac output is the volume of blood being pumped by the heart, in particular a ventricle in a minute. ... In medicine pulmonary artery catheterization is the insertion of a catheter into a pulmonary artery. ...

Lack of improvement with fluid resuscitation, therapy-resistant hyperkalemia, metabolic acidosis or fluid overload may necessitate artificial support in the form of dialysis or hemofiltration. Depending on the cause, a proportion of patients will never regain full renal function, thus having end stage renal failure requiring lifelong dialysis or a kidney transplant. In medicine, dialysis is a type of renal replacement therapy which is used to provide an artificial replacement for lost kidney function due to renal failure. ... In medicine, hemofiltration, also haemofiltration, is a renal replacement therapy similar to hemodialysis which is used almost exclusively in the intensive care setting. ... Chronic renal failure (CRF, or chronic kidney failure, CKF, or chronic kidney disease, CKD) is a slowly progressive loss of renal function over a period of months or years and defined as an abnormally low glomerular filtration rate, which is usually determined indirectly by the creatinine level in blood serum. ... In medicine, dialysis is a type of renal replacement therapy which is used to provide an artificial replacement for lost kidney function due to renal failure. ...

History

Before the advancement of modern medicine acute renal failure might be referred to as uremic poisoning. Uremia was the term used to describe the contamination of the blood with urine. Starting around 1847 this term was used to describe reduced urine output, now known as oliguria, that was thought to be caused by the urine mixing with the blood instead of being voided through the urethra. NLM (National Library of Medicine, contains resources for patients and healthcare professionals) Virtual Hospital (digital health sciences library by the University of Iowa) Online Medical Dictionary Collection of links to free medical resources Wikicities has a wiki about medicine: Medicine Categories: Medicine | Health ... Uremia is a toxic condition resulting from renal failure, when kidney function is compromised and urea, a waste product normally excreted in the urine, is retained in the blood. ... Human blood smear: a - erythrocytes; b - neutrophil; c - eosinophil; d - lymphocyte. ... This article or section is in need of attention from an expert on the subject. ... 1847 was a common year starting on Friday (see link for calendar). ... Oliguria and anuria are the decreased or absent production of urine, respectively. ... In anatomy, the urethra is a tube which connects the urinary bladder to the outside of the body. ...

Acute renal failure due to acute tubular necrosis (ATN) was recognised in the 1940s in the United Kingdom, where crush victims during the Battle of Britain developed patchy necrosis of renal tubules, leading to a sudden decrease in renal function.^[3] During the Korean and Vietnam wars, the incidence of ARF decreased due to better acute management and intravenous infusion of fluids.^[4] Acute tubular necrosis may be toxic or ischemic. ... This article does not cite any references or sources. ... Combatants United Kingdom Including combatants from:[1] Poland New Zealand Canada Czechoslovakia Belgium Australia South Africa France Ireland United States Jamaica Palestine Rhodesia Germany Including combatants from Italy Commanders Hugh Dowding Hermann Göring Strength 754 single-seat fighters 149 two-seat fighters 560 bombers 500 coastal 1,963 total...

See also

• Chronic renal failure
• Dialysis
• Hepatorenal syndrome
• Renal failure

In medicine, dialysis is a type of renal replacement therapy which is used to provide an artificial replacement for lost kidney function due to renal failure. ... Hepatorenal syndrome (HRS), also called hepatorenal failure, refers to acute renal failure that occurs in the setting of cirrhosis or fulminant liver failure associated with portal hypertension, usually in the absence of other disease of the kidney. ... Renal failure is the condition in which the kidneys fail to function properly. ...

References

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1. ^ Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P; Acute Dialysis Quality Initiative workgroup. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004 Aug;8(4):R204-12. Epub 2004 May 24. PMID 15312219 Full Text. Criteria for ARF (Figure).
2. ^ Lameire N, Van Biesen W, Vanholder R. Acute renal failure. Lancet 2005;365:417-30. PMID 15680458.
3. ^ Bywaters EG, Beall D. Crush injuries with impairment of renal function. Br Med J 1941;1:427-32. Reprinted in J Am Soc Nephrol 1998;9:322-32. PMID 9527411.
4. ^ Schrier RW, Wang W, Polle B, Mitra A. Acute renal failure: definitions, diagnosis, pathogenesis, and therapy. J Clin Invest 2004;114:5-14. PMID 15232604. Full text.