Acute Renal Failure

ATN

r

Most importantMost commonPrognosisNo Systemic Dz, Excellent recoverySystemic Dz: High mortalityRx:Water/Electrolyte balance, Dialysis (Peritoneal or Hemo)

Ischemic ATN

Gross

Swollen

Cortex bulging out of capsule

Cortex pale, medulla dark

LM

NO DIFFUSE NECROSIS of tubular epithelial cells

Lab Values

BUN

Cr

Oliguria 50%

Causes

Reduced renal perfusion

r

Leads to prerenal azotemia --> hence, elevated BUN & Cr

Hypovolemia

Shock

Renal vasoconstriction

Toxic ATN

Causes

Aminoglycoside

Gentamicin

Heavy Metals

Mercuric chloride

Arsenic

Organic compounds

CCL4

Rx

Water/Electrolytes

Dialysis

Hemo-

Peritoneal

TIN

r

Tubulointerstitial nephritis (TIN)akaAcute interstitial nephritisakaDrug-induced ____Allergic ___

Causes

Acute pyelonephritis

Drugs

NSAIDs

Diuretics

Antibiotics

Penicillin

Sulfonamide

Other

r

Rapid Review:LSEPb poisoningUrate nephropathyMultiple myeloma

Infection

Allergy

Clinical

Eosinophilia (50%)

Rx

Deal w/ the Source

Prednisone (part. benefit)

Transplant rejection

W/in Hours

Hyperacute

Pre-existing Ab to HLA/ABO Ag

Cyanotic, soft

Earliest is 3rd-7th day (wks to mos)

Acute

Edema, renal function normal after steroids

Cellular (interstitial)

Edema, hemorrhage, parenchymal necrosis

Vascular

Micro: endovasculitis

Myeloma kidney (Cast Nephropathy)

r

30% have severe ARF

Hard, brittle, bright, eosinophilic cast in tubules

Bence-Jones protein

Multinucleated giant cells surround casts

Concomitant amyloidosis (15%)

Crescentic GN

P-ANCA

Microscopic PAN

anti-GBM

Goodpasture's

Immune complex Dz

Thrombotic microangiopathies

DIC

Causes

Bactermia

Abruptio placentae

Toxemia of pregnancy

Bilateral renal coritcal necrosis

r

This is possiblePrognosis is bad

HUS

r

E.coli (Hemorrhagic)Hamburger

Children

Triad

Hemolysis

Uremia

Thrombocytopenia

Most recover

r

Some develop CRF

TTP

Women

CNS problems

Fever

Purpura