Acute renal failure (ARF), also known as acute kidney failure or acute kidney injury, 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. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings N00-N39 - Diseases of the Genitourinary system: urinary system (N00-N08 Glomerular diseases Prefixes. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Renal function, in Nephrology, is an indication of the state of the Kidney and its role in Renal physiology. The kidneys are complicated organs that have numerous biological roles Urea is an Organic compound with the Chemical formula ( N[[hydrogen H]]22 C[[oxygen O]] Creatinine is a break-down product of Creatine phosphate in Muscle, and is usually produced at a fairly constant rate by the body (depending on muscle mass 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. In Medicine, metabolic acidosis is a process which if unchecked leads to acidemia (i Hyperkalemia ( AE) or Hyperkalaemia ( BE) is an elevated blood level of the Electrolyte Potassium. Fluid balance is the concept of Human homeostasis that the amount of Fluid lost from the body is equal to the amount of fluid taken in It can be characterised by oliguria or anuria (decrease or cessation of urine production), although nonoliguric ARF may occur. Oliguria and anuria are the decreased or absent production of Urine, respectively Oliguria and anuria are the decreased or absent production of Urine, respectively It is a serious disease and treated as a medical emergency. A medical emergency is an Injury or Illness that is acute and poses an immediate risk to a person's life or long term health

Kidney showing marked pallor of the cortex, contrasting to the darker areas of surviving medullary tissue. The patient died with acute renal failure

Causes

Acute renal failure is usually categorised (as in the flowchart below) according to pre-renal, renal and post-renal causes. A flowchart is a Schematic representation of an Algorithm or a stepwise process, showing the steps as boxes of various kinds and their order by connecting

• Pre-renal (causes in the blood supply):
  • hypovolemia (decreased blood volume), usually from shock or dehydration and fluid loss or excessive diuretics use. In Physiology and Medicine, hypovolemia (also hypovolaemia is a state of decreased Blood volume more specifically decrease in volume of Blood plasma Dehydration ( hypohydration) is the removal of Water ( hydro in ancient Greek) from an object A diuretic is any Drug that elevates the rate of urination ( Diuresis)
  • 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)
  • infection usually sepsis, systemic inflammation due to infection

• Renal (damage to the kidney itself):
  • toxins or medication (e. Hepatorenal syndrome (HRS refers to Acute renal failure that occurs in the setting of Cirrhosis or Fulminant Liver failure, sometimes also associated In Physiology, perfusion is the process of nutritive delivery of Arterial Blood to a Capillary bed in the Biological tissue. Liver failure is the inability of the Liver to perform its normal synthetic and metabolic function as part of normal physiology Cholesterol embolism (often cholesterol crystal embolism or atheroembolism, sometimes blue toe or purple toe syndrome or trash foot 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 Not to be confused with Nephritic syndrome Nephrotic syndrome is a nonspecific disorder in which the Kidneys are damaged to leak large An infection is the detrimental Colonization of a host Organism by a foreign Species. Sepsis is a serious medical condition characterized by a whole-body inflammatory state (called a Systemic inflammatory response syndrome or SIRS caused A toxin ( Greek:, toxikon, lit (poison for use on arrows is a Poisonous substance produced by living cells or organisms that is active at very low Medication, also referred to as medicine, can be loosely defined as any substance intended for use in the diagnosis cure mitigation treatment or prevention of disease 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 be 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. Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher An aminoglycoside is a molecule composed of a sugar group and an Amino group Iodinated contrast is a form of intravenous Radiocontrast (radiographic dye containing Iodine, which enhances the visibility of vascular structures and organs during Lithium in pharmacology refers to use of the Lithium Ion, Li+ as a drug Rhabdomyolysis is the rapid breakdown ( Lysis) of Skeletal muscle tissue ( rhabdomyo) due to injury to muscle tissue Myoglobin is a single-chain globular Protein of 153 Amino acids containing a Heme ( Iron -containing Porphyrin) Prosthetic Injury or bodily injury is Damage or Harm caused to the Structure or function of the Body caused by an outside agent or The statins (or HMG-CoA reductase inhibitors) form a class of hypolipidemic drugs used to lower Cholesterol levels in people with or at risk of Cardiovascular Stimulant drugs are Drugs that temporarily increase alertness and awareness Hemolysis (or haemolysis)—from the Greek Hemo-, Greek meaning blood - Lysis, meaning to break open—is the breaking Red blood cells are the most common type of Blood cell and the Vertebrate body's principal means of delivering Oxygen to the body tissues via the Blood Hemoglobin ( also spelled haemoglobin and abbreviated Hb or Hgb) is the Iron -containing Oxygen -transport Metalloprotein Sickle-cell disease or sickle-cell anaemia (or anemia) is a Blood disorder characterized by Red blood cells that assume an abnormal rigid Systemic lupus erythematosus ( SLE or lupus,) is a chronic autoimmune disease that can be fatal though with recent medical advances fatalities are becoming Multiple myeloma (also known as MM, myeloma, plasma cell myeloma, or as Kahler's disease after Otto Kahler) is a type of Hypercalcaemia (in American English '''Hypercalcemia''' is an elevated calcium level in the Blood. Chronic kidney disease (CKD also known as chronic renal disease, is a progressive loss of renal function over a period of months or years Glomerulonephritis, also known as glomerular nephritis, abbreviated GN, is a renal disease characterized by Inflammation of the glomeruli Goodpasture’s syndrome (also known as Goodpasture’s disease and anti-glomerular basement membrane disease) is a rare condition characterised by rapid destruction Wegener's granulomatosis is a form of Vasculitis that affects the Lungs Kidneys and other organs Systemic lupus erythematosus ( SLE or lupus,) is a chronic autoimmune disease that can be fatal though with recent medical advances fatalities are becoming Medication, also referred to as medicine, can be loosely defined as any substance intended for use in the diagnosis cure mitigation treatment or prevention of disease
  • benign prostatic hypertrophy or prostate cancer. Benign prostatic hyperplasia ( BPH) also known as nodular hyperplasia, benign prostatic hypertrophy (technically a misnomer or benign enlargement of
  • kidney stones. Kidney stones, also called renal calculi, are solid concretions (crystal aggregations of dissolved minerals in Urine; calculi typically form
  • due to abdominal malignancy (e. g. ovarian cancer, colorectal cancer). Ovarian cancer is a cancerous growth arising from an Ovary. The cancer most commonly forms in the lining of the ovary (resulting in epithelial Colorectal cancer, also called colon cancer or large bowel cancer, includes Cancerous growths in the colon, Rectum and
  • obstructed urinary catheter. In urinary catheterization, a plastic tube known as a urinary Catheter (such as a Foley catheter) is inserted into a patient's bladder via their

Diagnosis

In general, renal failure is diagnosed when either creatinine or blood urea nitrogen tests are markedly elevated in an ill patient, especially when oliguria is present. Creatinine is a break-down product of Creatine phosphate in Muscle, and is usually produced at a fairly constant rate by the body (depending on muscle mass Previous measurements of renal function may offer comparison, which is especially important if a patient is known to have chronic renal failure as well. Chronic kidney disease (CKD also known as chronic renal disease, is a progressive loss of renal function over a period of months or years 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. A blood test is a laboratory analysis performed on a Blood sample that is usually extracted from a Vein in the arm using a needle, or via Urine is a liquid waste product of the body secreted by the Kidneys by a process of filtration from Blood and Excreted through the Urethra.

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 or 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. A biopsy (in Greek: βίος life and όψη look/appearance is a Medical test involving the removal of cells or tissues Prognosis (older Greek πρόγνωσις modern Greek πρόγνωση - literally fore-knowing foreseeing) is a medical term denoting the

Treatment

Acute renal failure may be reversible if treated promptly and appropriately. Resuscitation to normotension and a normal cardiac output is key. Cardiac output (Q is the volume of blood being pumped by the Heart, in particular by a ventricle in a minute 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 urinary catheterization, a plastic tube known as a urinary Catheter (such as a Foley catheter) is inserted into a patient's bladder via their In the absence of fluid overload, administering intravenous fluids is typically the first step to improve renal function. Intravenous therapy or IV therapy is the giving of Liquid substances directly into a Vein. Fluid administration may be monitored with the use of a central venous catheter to avoid over- or under-replacement of fluid. In Medicine, a central venous catheter ( CVC or central venous line or central venous access catheter) is a Catheter placed into a If the cause is obstruction of the urinary tract, relief of the obstruction (with a nephrostomy or urinary catheter) may be necessary. 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 In urinary catheterization, a plastic tube known as a urinary Catheter (such as a Foley catheter) is inserted into a patient's bladder via their 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 Medicine, metabolic acidosis is a process which if unchecked leads to acidemia (i Hyperkalemia ( AE) or Hyperkalaemia ( BE) is an elevated blood level of the Electrolyte Potassium. Sodium bicarbonate or sodium hydrogen carbonate is the Chemical compound with the formula NaHCO3 In Medicine, dialysis (from Greek "dialusis" meaning dissolution "dia" meaning through and "lusis" meaning loosening is primarily

Should hypotension prove a persistent problem in the fluid replete patient, inotropes such as norepinephrine and/or dobutamine may be given to improve cardiac output and hence renal perfusion. An inotrope (ˈaɪnətroʊp is an agent that alters the force or energy of Muscular contractions Negatively inotropic agents weaken the force of muscular contractions Norepinephrine ( INN) (abbreviated norepi or NE) or noradrenaline ( BAN) (abbreviated NA or NAd) is a Dobutamine is a Sympathomimetic Drug used in the treatment of Heart failure and Cardiogenic shock. Cardiac output (Q is the volume of blood being pumped by the Heart, in particular by a ventricle in a minute While a useful pressor, there is no evidence to suggest that dopamine is of any specific benefit,^[3] and at least a suggestion of possible harm. Dopamine is a Hormone and Neurotransmitter occurring in a wide variety of animals including both vertebrates and invertebrates 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. In Medicine pulmonary artery catheterization (PAC is the insertion of a Catheter into a Pulmonary artery.

The use of diuretics such as furosemide, while widespread and sometimes convenient in ameliorating fluid overload, does not reduce the risk of complications and death. A diuretic is any Drug that elevates the rate of urination ( Diuresis) Furosemide ( INN) or frusemide (former BAN) is a Loop diuretic used in the treatment of congestive Heart failure and Edema ^[4] In practice, diuretics may simply mask things, making it more difficult to judge the adequacy of resuscitation.

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. In Medicine, dialysis (from Greek "dialusis" meaning dissolution "dia" meaning through and "lusis" meaning loosening is primarily In Medicine, hemofiltration, also haemofiltration, is a Renal replacement therapy similar to Hemodialysis which is used almost exclusively in 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. Chronic kidney disease (CKD also known as chronic renal disease, is a progressive loss of renal function over a period of months or years In Medicine, dialysis (from Greek "dialusis" meaning dissolution "dia" meaning through and "lusis" meaning loosening is primarily Kidney transplantation or renal transplantation is the Organ transplant of a Kidney in a patient with End-stage renal disease.

History

Before the advancement of modern medicine, acute renal failure might be referred to as uremic poisoning. Medicine is the art and science of healing It encompasses a range of Health care practices evolved to maintain and restore Human Health by the Uremia was the term used to describe the contamination of the blood with urine. Uremia is a term used to loosely describe the illness accompanying kidney failure (also called renal failure Blood is a specialized Bodily fluid that delivers necessary substances to the body's cells ��such as nutrients and oxygen—and transports Waste products Urine is a liquid waste product of the body secreted by the Kidneys by a process of filtration from Blood and Excreted through the Urethra. Starting around 1847 this term was used to describe reduced urine output, now known as oliguria, which was thought to be caused by the urine's mixing with the blood instead of being voided through the urethra. Year 1847 ( MDCCCXLVII) was a Common year starting on Friday (link will display the full calendar of the Gregorian Calendar (or a Common Oliguria and anuria are the decreased or absent production of Urine, respectively In Anatomy, the urethra (from Greek ουρήθρα - ourethra) is a tube which connects the Urinary bladder to the outside of

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. Acute tubular necrosis or ( ATN) is a medical condition involving the death of tubular cells that form the Tubule that transports Urine to the Ureters The 1940s decade ran from 1940 to 1949 Events and trends The 1940s was a period between the radical 1930s and the conservative 1950s which also leads the period to be The Battle of Britain (German ''Luftschlacht um England'' is the name given to the sustained strategic effort by the German Luftwaffe during the summer and ^[5] During the Korean and Vietnam wars, the incidence of ARF decreased due to better acute management and intravenous infusion of fluids. ^[6]

See also

• Chronic kidney disease
• Dialysis
• Hepatorenal syndrome
• Renal failure

References

1. ^ Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P; Acute Dialysis Quality Initiative workgroup. Chronic kidney disease (CKD also known as chronic renal disease, is a progressive loss of renal function over a period of months or years In Medicine, dialysis (from Greek "dialusis" meaning dissolution "dia" meaning through and "lusis" meaning loosening is primarily Hepatorenal syndrome (HRS refers to Acute renal failure that occurs in the setting of Cirrhosis or Fulminant Liver failure, sometimes also associated Renal failure or kidney 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. This article is about the journal For other uses of the term "lancet" see Lancet (disambiguation. PMID 15680458.
3. ^ Holmes CL, Walley KR (2003). "Bad medicine: low-dose dopamine in the ICU". Chest 123 (4): 1266–75. doi:10.1378/chest.123.4.1266. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 12684320.  
4. ^ Uchino S, Doig GS, Bellomo R, et al (2004). "Diuretics and mortality in acute renal failure". Crit. Care Med. 32 (8): 1669–77. doi:10.1097/01.CCM.0000132892.51063.2F. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 15286542.  
5. ^ 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.
6. ^ 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.