Editing Acute renal failure (section)

== '''Aetiology''' ==

* '''Pre-renal (75%) - can lead to ATN in hours.''' The kidney is structurally and functionally intact, but blood flow and GFR are reduced.
** Sepsis
** Hypovolaemia
** Low cardiac output
* '''Renal (20%) - involves parenchymal damage'''
** Acute tubular necrosis - commonest
** Renal ischaemia - hypoxia, hypo-perfusion
** Medications
*** Nsaids, ACE inhibitors
*** Note trimethoprim can cause a 30% rise in creatinine, without necessarily reflecting kidney injury, due to competitive inhibition of creatinine metabolism
** Iodinated contrast media
*** Can occur within 48 hours of administration
*** Pre-hydration
*** ?NAC
*** Systematic reviews now saying this may not really exist
** Interstitial nephritis
** Hepatorenal syndrome
** Abdominal compartment syndrome
* '''Post-renal (5%) - obstruction and back-pressure'''
** Bilateral ureteric obstruction
** Bladder outlet obstruction