Post Date December, 02 2023
1. Prerenal acute renal failure
Due to pre renal factors, the effective circulating blood volume decreases, resulting in renal function damage caused by insufficient renal blood flow perfusion. "The glomerular filtration rate decreases, the reabsorption of urea nitrogen, water, and sodium by the renal tubules increases relatively, and the patient's blood urea nitrogen increases, urine volume decreases, and urine specific gravity increases.". In patients with pre renal acute renal failure, the structure of the glomerulus and renal tubules remains intact. When the renal blood perfusion returns to normal, the glomerular filtration rate also recovers. However, severe or sustained renal hypoperfusion can cause pre renal acute renal failure to develop into acute tubular necrosis.
(1) Effective blood volume reduction ① Hemorrhagic trauma, surgery, postpartum, digestive tract, etc. ② Loss of digestive fluid, vomiting, diarrhea, gastrointestinal decompression, etc Use diuretics and diabetes acidosis for kidney loss. ④ Loss of skin and mucous membranes, burns, high fever, etc Third lacunar loss crush syndrome, pancreatitis, hypoalbuminemia, etc.
(2) Reduced cardiac output includes congestive heart failure, cardiogenic shock, pericardial tamponade, and severe arrhythmia.
(3) Systemic vasodilation, sepsis, liver failure, allergic reactions, drugs (hypotensives, anesthetics, etc.).
(4) The use of drugs such as norepinephrine for renal vasoconstriction, and hepatorenal syndrome.
(5) Drugs that affect renal hemodynamic changes, such as angiotensin converting enzyme inhibitors, and non steroidal anti-inflammatory drugs.
2. Postrenal acute renal failure
(1) Ureteral obstruction: ① Intraluminal obstruction with crystals (uric acid, etc.), stones, blood clots, etc Extraluminal obstruction, retroperitoneal fibrosis, tumor, hematoma, etc.
(2) Bladder neck obstruction, prostatic hypertrophy, bladder neck fibrosis, neurogenic bladder, prostate cancer, etc.
(3) Urethral obstruction, stenosis, etc.
3. Renal acute renal failure
(1) Acute tubular necrosis is the most common renal tubular disease. The etiology is divided into renal ischemia and nephrotoxicity The etiology of pre renal acute renal failure due to renal ischemia was not resolved in time Common nephrotoxic substances in renal poisoning include drugs, contrast agents, heavy metals, biotoxins, organic solvents, myoglobinuria, hemoglobinuria, light chain proteins, hypercalcemia, etc.
(2) Glomerular diseases such as progressive nephritis and lupus nephritis.
(3) Acute interstitial nephritis Acute (allergic) drug-induced interstitial nephritis, sepsis, severe infection, etc.
(4) Primary or secondary necrotizing vasculitis, malignant hypertension, and renal damage in renal microvascular diseases.
(5) Acute renal macrovascular disease: Bilateral or unilateral renal artery/vein thrombosis or cholesterol crystal embolism in the kidney; Hemorrhage from dissecting aneurysm, rupture of renal artery.
(6) Some chronic kidney diseases, under the influence of factors that promote the deterioration of chronic renal failure, lead to the acute exacerbation of chronic renal failure and the clinical manifestations of acute renal failure.
