ARF due to other causes as partial obstruction may present as polyuria. ARF due to postrenal obstruction may present as anuria. Diagnosis Renal failure is manifested by the rise of serum creatinine. [doctorslounge.com]

Physical findings Asterixis and myoclonus Pericardial or pleural rub Peripheral edema (if volume overload is present) Pulmonary rales (if volume overload is present) Elevated right atrial pressure (if volume overload is present) TABLE 1 Key Symptoms [aafp.org]

If the kidney concentration is impaired and the patient can achieve a specific gravity of only 1.010, oliguria is present at urine volumes <1000–1500 mL/day. [accessmedicine.mhmedical.com]

Consider, for example, a patient who presents with pneumonia and an abnormal creatinine level. Assume for this example that the patient’s baseline creatinine is 1.0 mg/dl and he presents with a creatinine of 1.3 mg/dl. [clinicaladvisor.com]

A renal biopsy may reveal the specific underlying disease, but crescent formation in >50% of glomeruli is usually present. [unboundmedicine.com]

• Acutely Ill Patient

  Avoidance of nephrotoxic drugs and iodinated contrast agents in these patients reduces the risk of them developing AKI. All acutely ill patients in hospital should be closely monitored for signs of developing AKI. [patient.info]

  However, Bouchard et al demonstrated that fluid accumulation in critically ill patients with acute illness is associated with increased mortality, and is not associated with recovery of renal function42. [ncbi.nlm.nih.gov]

  […] of acute kidney injury in critically-ill patients.. [anesthesiology.pubs.asahq.org]

  Oliguria as predictive biomarker of acute kidney injury in critically ill patients. [ccforum.biomedcentral.com]

• Malnutrition

  Later, anuria (the complete non-passage of urine), convulsions, GI bleeding, malnutrition, and various neuropathies may occur. The skin may even turn yellowish-brown color. [availclinical.com]

  […] death in acute renal failure are Hyperkalaemia (see Hyperkalaemia page) Pulmonary oedema Infection - renal failure is an immunosuppressed state, and intravascular catheters, oedema etc put patients at great risk of bacterial infections Uraemia - the malnutrition [edrep.org]

  Different mechanisms have been suggested to explain this phenomenon: inflammation, vasodilatation or increased vascular permeability, increased nonspecific catabolism, malnutrition or liver dysfunction leading to reprioritization of synthesis, or increased [karger.com]

• Hypoxemia

  Hypotension with bradycardia may indicate beta-blockade, heart block, high neuraxial blockade or prolonged hypoxemia. [ncbi.nlm.nih.gov]

• Multiple Organ Dysfunction Syndrome

  (HHNS), multiple organ dysfunction syndrome, urinary obstruction/urinary retention, diabetic ketoacidosis (DKA), pre-eclampsia, and urinary tract infections, among other conditions. [en.wikipedia.org]

• Pneumonia

  […] and Mycoplasma Pneumoniae screening were negative. [elsevier.es]

  […] procedure.During peritoneal dialysis, position the patient carefully: elevate the head of the bed.Doing so would reduce the pressure on the diaphragm and can aid in respiration.Watch out for complications such as peritonitis, atelectasis, hypokalemia, pneumonia [nurseslabs.com]

  Consider, for example, a patient who presents with pneumonia and an abnormal creatinine level. Assume for this example that the patient’s baseline creatinine is 1.0 mg/dl and he presents with a creatinine of 1.3 mg/dl. [clinicaladvisor.com]

  Alveolar concentrations of piperacillin/tazobactam administered in continuous infusion to patients with ventilator-associated pneumonia. Crit Care Med. 2008;36:1500–6. [annalsofintensivecare.springeropen.com]

• Hypotension

  The aim of the study is to analyze prolonged hypotension due to acute myocardial infarction in older and younger patients and to answer the question: does prolonged hypotension, due to acute myocardial infarction, lead to acute renal failure or to functional [ncbi.nlm.nih.gov]

  […] with severe congestive heart failure or underlying renal disease, including renal artery stenosis), treatment with angiotensin converting enzyme inhibitors or angiotensin-II receptor antagonists that affect this system has been associated with acute hypotension [mymemory.translated.net]

  We describe a Weil's disease case with oliguric and hypokalaemic acute renal failure, hypotension, jaundice and lung haemorrhage. We performed haemodialysis treatment, steroid and antibiotic therapy with complete recovery of renal function. [elsevier.es]

• Heart Disease

  In a study of 226 children with acute renal failure, Bunchman et al reported that congenital heart disease, acute tubular necrosis, sepsis, and bone marrow transplantation were the most common causes. [7] A retrospective review of 248 patients with a [emedicine.medscape.com]

  High blood pressure Heart failure Kidney diseases Liver diseases Certain cancers and their treatments Complications Potential complications of acute kidney failure include: Fluid buildup. [mayoclinic.org]

  Decreased cardiac output: Acute heart diseases such as myocardial ischemia, pulmonary embolism or decreased cardiac output due to mechanical ventilation. [urology-textbook.com]

  They found significant univariate associations between AKI and the following risk factors: age, emergency and high-risk surgery (intraperitoneal, intrathoracic, suprainguinal vascular procedures), ischemic heart disease, congestive heart failure, higher [ncbi.nlm.nih.gov]

• Jaundice

  The most severe form of Leptospirosis, characterized by jaundice, acute kidney injury and haemorrhagic diathesis, is referred as Weil's disease. [elsevier.es]

• Flank Pain

  Symptoms of Postrenal Kidney Failure Flank pain, abdominal pain or neurological symptoms are suspicious for a postrenal kidney failure. [urology-textbook.com]

  […] epididymitis精巣上体炎 erectile dysfunction (ED)勃起不全 erythropoietinエリスロポエチン essential hypertension本態性高血圧 etymology語源 excrete排出する（される） excretory urography排泄性尿路造影 extracellular fluid　(ECF)細胞外液 extracorporeal shock wave lithotripsy (ESWL)体外衝撃波結石破砕 f flaccid type 弛緩型 flank [tokyo-med.ac.jp]

Acute kidney injury 2016: diagnosis and diagnostic workup. Crit Care. 2016;20(1):299. doi: 10.1186/s13054-016-1478-z. [PMC free article] [PubMed] [CrossRef] [Google Scholar] 35. [ncbi.nlm.nih.gov]

Acute kidney injury 2016: diagnosis and diagnostic workup. Crit Care. 2016;20(1):299. [PubMed] 7. Muriithi A, Nasr S, Leung N. Utility of urine eosinophils in the diagnosis of acute interstitial nephritis. [emcrit.org]

• Atelectasis

  […] ability to withstand the procedure.During peritoneal dialysis, position the patient carefully: elevate the head of the bed.Doing so would reduce the pressure on the diaphragm and can aid in respiration.Watch out for complications such as peritonitis, atelectasis [nurseslabs.com]

• Hyponatremia

  Hyponatremia may result from fluid overload (dilutional) or kidney’s inability to conserve sodium. Hypernatremia indicates total body water deficit. Serum potassium. [nurseslabs.com]

  Hyponatremia usually is moderate (serum sodium, 125 to 135 mmol/L) and correlates with a surplus of dietary or intravenous water intake. Normochromic-normocytic anemia with a hematocrit of 25 to 30% is typical. [merckmanuals.com]

  Acute symptomatic hyponatremia is rare in the setting of AKI, and should be treated with hypertonic saline. In severely hyponatremic patients (< 120 meq/L) requiring hemodialysis, the dialysate sodium bath should be lowered to 130 mmol/L. [renalandurologynews.com]

  The resultant polyuria, hypokalemia, and hyponatremia should be managed with vigorous fluid replacement guided by frequent determinations of urinary flow rate, urinary electrolytes, and serum electrolytes. [emedicine.medscape.com]

  Hypertonic bicarbonate ampules (50 ml ampules of 1 mEq/ml bicarbonate) are great for patients with hyponatremia. For example, two ampules (100 mEq/L) will typically increase the bicarbonate and sodium by ~3 mEq/L. [emcrit.org]

• Potassium Increased

  Hyperkalemia Potassium increases 0.5 mmol/l/day during anuria. Hyperkalemia is particularly serious with additional cell disintegration (tumor lysis, hemolysis, rhabdomyolysis). [urology-textbook.com]

Treatment Of Oliguria Oliguria does not have a single treatment recommendation. Being a symptom rather than a disease, it calls for treatment appropriate to whatever is causing it. [kidneypedia.net]

If your kidneys fail, you need treatment to replace the work they normally do. The treatment options are dialysis or a kidney transplant. Each treatment has benefits and drawbacks. [icdlist.com]

Removal of nephrotoxins, rapid treatment of the triggering factors, and attention to cardiac output and mean arterial pressure remain the cornerstones of the prevention and treatment of AKI in ICU. [oxfordmedicine.com]

Treatment Treatment of acute renal failure usually should be conservative and largely supportive. It requires careful and precise management. All patients will require close monitoring, many of them within intensive care settings. [doctorslounge.com]

Patients with sepsis, or with a severe heart insufficiency, often require intensive care treatments. [lecturio.com]

Prognosis The prognosis for those suffering from oliguria depends on what is causing the symptom but in most cases is quite good, provided the acute condition is promptly and properly treated. [kidneypedia.net]

CONCLUSIONS: Lactate is an objective parameter that can predict prognosis and contributes to a better management of acute kidney injury in hemodialysis patients. [ncbi.nlm.nih.gov]

Indicators of poor prognosis include older age, multiple organ failure, oliguria, hypotension, number of transfusions and acute on chronic kidney disease. Prognosis is closely related to the underlying cause. [patient.info]

Anemia can also frequently occur and the prognosis depends on the underlying cause. Treatment for chronic renal failure generally includes restricting the patient’s water and protein intake and the usage of diuretics. [availclinical.com]

Principal causes of oliguric acute kidney injury in neonates The etiology of oliguria varies with age, and the common causes in neonates and children are listed separately. [emedicine.medscape.com]

(look at etiology) Prognosis lower rates of recovery in patients > 65 years of age increased risk of end-stage renal disease, chronic kidney disease, and mortality Presentation Symptoms may be asymptomatic oliguria anuria polyuria confusion Physical [medbullets.com]

While they may help in the diagnosis and management of very specific etiologies like hepatorenal syndrome, most of the time a fluid challenge or diuresis will be the diagnostic and therapeutic tests of choice. JAMA. 1976 Aug 9;236(6):579-81. [medicine-matters.blogs.hopkinsmedicine.org]

The principal etiologies of acute kidney injury while in hemodialysis were sepsis (39.2%), and severe dehydration (10.8%). [ncbi.nlm.nih.gov]

In this article we highlight the epidemiology, general causes, and evaluation of acute renal failure in adults. [nejm.org]

Methods Statistics Trigonometry Medical & Nursing Anatomy Anesthesiology Audiology Bacteriology Biochemistry Bioethics Biomedical Science Cardiology Cardiovascular Childbirth Chiropractic Dentistry Dermatology Diagnostic Imaging Drugs Endocrinology Epidemiology [brainscape.com]

Epidemiology/Prognosis Numerous studies have indicated that AKI is common, is increasing in incidence and is associated with considerable morbidity and mortality. [clinicaladvisor.com]

In 2013, Rhone et al 62 evaluated the epidemiology and impact of nephrotoxic medication exposure in 107 very low birth weight (VLBW) infants. [pediatrics.aappublications.org]

Acute kidney injury: epidemiology and diagnostic criteria. Curr Opin Crit Care. 2006; 12: 531-537. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG. Acute Kidney Injury Network. [austinpublishinggroup.com]

In the past five decades, several important causes of acute renal failure and the pathophysiologic mechanisms that underlie renal dysfunction have come to be understood. [nejm.org]

Etiology and Pathophysiology of Acute Renal Insult Causes of Acute Renal Insult Because of various pathophysiologic processes, kidney function can diminish rapidly. [lecturio.com]

While some studies have demonstrated that isolated oliguria without a concomitant increase in serum creatinine is associated with higher mortality rates, different underlying pathophysiological mechanisms suggest varied clinical importance of reduced [ncbi.nlm.nih.gov]

The most common trigger in ICU patients is sepsis—the pathophysiology of septic AKI is poorly understood and probably involves intrarenal haemodynamic and inflammatory processes. [oxfordmedicine.com]

You are here: Urology Textbook > Kidneys > Renal insufficiency > Acute renal injury Acute kidney injury – acute renal failure (1/2): causes, pathophysiology and symptoms Acute kidney injury – acute renal failure (2/2): Diagnosis and treatment Review literature [urology-textbook.com]

Administering fluids in the setting of radiocontrast exposure may prevent development of AKI. [ncbi.nlm.nih.gov]

Meticulous attention must be paid to preventing or treating complications of AKI. [renalandurologynews.com]

Dialysis is a great treatment for 1 and 2 and prevents 4. Careful conservative management can prevent 1-3 and delay 4, allowing recovery to occur. [edrep.org]

Prevention of post procedural acute kidney injury in the catheterization laboratory in a real-world population. Int J Cardiol. 2016 Oct 11. 226:42-47. [Medline]. Briguori C. [emedicine.medscape.com]