Featured Books


Classification and Major Causes of Acute Renal Failure

Prerenal ARF 
I. Hypovolemia
  A. Increased extracellular fluid losses: hemorrhage
  B. Gastrointestinal fluid loss: vomiting, diarrhea, enterocutaneous fistula
  C. Renal fluid loss: diuretics, osmotic diuresis, hypoadrenalism, nephrogenic diabetes insipidus
  D. Extravascular sequestration: burns, pancreatitis, severe hypoalbuminemia (hypoproteinemia)
  E. Decreased intake: dehydration, altered mental status
II. Altered renal hemodynamics resulting in hypoperfusion
  A. Low cardiac output state: diseases of the myocardium, valves, and pericardium (including tamponade); pulmonary hypertension or massive pulmonary embolism leading to right and left heart failure; impaired venous return (e.g., abdominal compartment syndrome or positive pressure ventilation)
  B. Systemic vasodilation: sepsis, antihypertensives, afterload reducers, anaphylaxis
  C. Renal vasoconstriction: hypercalcemia, catecholamines, calcineurin inhibitors, amphotericin B
  D. Impairment of renal autoregulatory responses: cyclooxygenase inhibitors (e.g., nonsteroidal anti-inflammatory drugs), angiotensin-converting enzyme inhibitors, or angiotensin II receptor blockers
  E. Hepatorenal syndrome
Intrinsic ARF 
I. Renovascular obstruction (bilateral, or unilateral in the setting of one kidney)
  A. Renal artery obstruction: atherosclerotic plaque, thrombosis, embolism, dissection aneurysm, large vessel vasculitis
  B. Renal vein obstruction: thrombosis or compression
II. Diseases of the glomeruli or vasculature
  A. Glomerulonephritis or vasculitis
  B. Other: thrombotic microangiopathy, malignant hypertension, collagen vascular diseases (systemic lupus erythematosus, scleroderma), disseminated intravascular coagulation, preeclampsia
III. Acute tubular necrosis
  A. Ischemia: causes are the same as for prerenal ARF, but generally the insult is more severe and/or more prolonged
  B. Infection, with or without sepsis syndrome
  C. Toxins:
    1. Exogenous: radiocontrast, calcineurin inhibitors, antibiotics (e.g., aminoglycosides), chemotherapy (e.g., cisplatin), antifungals (e.g., amphotericin B), ethylene glycol
    2. Endogenous: rhabdomyolysis, hemolysis
IV. Interstitial nephritis
  A. Allergic: antibiotics (β-lactams, sulfonamides, quinolones, rifampin), nonsteroidal anti-inflammatory drugs, diuretics, other drugs
  B. Infection: pyelonephritis (if bilateral)
  C. Infiltration: lymphoma, leukemia, sarcoidosis
  D. Inflammatory, nonvascular: Sjögren's syndrome, tubulointerstitial nephritis with uveitis
V. Intratubular obstruction
  A. Endogenous: myeloma proteins, uric acid (tumor lysis syndrome), systemic oxalalosis
  B. Exogenous: acyclovir, gancyclovir, methotrexate, indinavir
Postrenal ARF (Obstruction) 
I. Ureteric (bilateral, or unilateral in the case of one kidney): calculi, blood clots, sloughed papillae, cancer, external compression (e.g., retroperitoneal fibrosis)
II. Bladder neck: neurogenic bladder, prostatic hypertrophy, calculi, blood clots, cancer
III. Urethra: stricture or congenital valves

Referensi : Harrison's Principles of Internal Medicine 17th Edition (McGraw-Hill) 2008

Copyright 2010 ReadingFirst | Digital Bookstore - All Rights Reserved.
Designed by Web2feel.com | Bloggerized by Lasantha - Premiumbloggertemplates.com | Affordable HTML Templates from Herotemplates.com.