•This will accompany any disease that involves hypovolemia, low cardiac
output, systemic dilation, or selective intrarenal vasoconstriction.
Prerenal Failure
• Hypovolemia
– GI loss: vomiting, diarrhea
– Renal loss: diuresis, hypo adrenalism, osmotic
diuresis (DM)
– Sequestration: pancreatitis, peritonitis, trauma,
low albumin.
– Hemorrhage, burns, dehydration.
Prerenal Failure
• Low CO
– Myocardial diseases
– Valvular heart disease
– Pericardial disease
– Tamponande
– Pulmonary HTN
– +ve pressure mechanical ventillation
Prerenal Failure
• Renal vasoconstriction: hyper Ca, norepi, epi, cyclosporine,
tacrolimus, ampho B.
• Cardiorenal syndrome
• This is not the case in renal injury (absorptive mechanisms are broken). In
either case Cr is NOT reabsorbed. So we have the makings of a comparative
ratio. The cut off is 1%.
U Na X P Cr
P Na X U Cr
• Clearance of Na+ = Urine [Na+] x Urine Volume
Serum [Na+]
Cut-off 1%
• FE Urea = U urea X P Cr
P urea X U Cr
Cut-off 40%
Intrinsic Renal Disease
• ARF DOES NOT EQUAL ATN.
• causes.
– Glomerulus : oliguria, smoky urine, proteinuria>0.5
gms/day, hypertension,dysmorphic RBCs, RBC casts
– Vessels
– Interstitum: white blood cell cast, eosinophiluria
– Tubules : epithelial casts
GN
• Red blood cell casts are the classic
finding.
• Dysmorphic RBCs.
– In the extreme form this can lead to bilateral renal cortical necrosis
• Three phases:
– Oliguric phase
– Recovery phase
ATN: Ischemic
• Renal vasoconstriction
• Systemic dilation
ATN : Toxic
• Exogenous • Endogenous
– Radiocontrast
– Myoglobin
– CSP
– Hemoglobin
– TAC
– Uric acid
– Amino glycosides
– Chemotherapy – Oxalate
ADQI, 2002
Biomarker Name Sample source Cardiac surgery Contrast nephropathy Septic or ICU Kidney Transplant Commercial test
Devarajan P & Williams LM, Semin Nephrol. 2007 November ; 27(6): 637–651.
Management of Acute Kidney Injury
• Diet: proteins are restricted 0.8 gm/ Kgm/day, Potassium and phosphorous
are restricted. Calcium is allowed liberally. The amount of fluids given is
guided by the amount of urine plus 500ml. If temperature is high
compensate for it.
Management of Acute Kidney Injury
• Drugs: the doses of all drugs administered to the patient should be adjusted to
the level of kidney functions. Hyperkalemia is treated by potassium restriction
and the administration of cation exchange resins. Hyperphosphatemia by
protein restriction and calcium carbonate which acts as phosphate binder and
supplies calcium. Acidosis is combated by Na bicarbonate. Anemia if severe is
treated by I.V. iron and recombinant Erythropoietin.
• Dialysis:
Treatment
• Prevention is the key.
– Use of NSAIDS, ACIs, ARBs, diuretics should be used sparingly in patients who are
• Foley catheter
• Nephrostomy tube
• Stenting