Acute Renal Failure

ARF is classified according to the primary cause: prerenal, intrinsic, and postrenal. Volume depletion is the most common prerenal cause. Intrinsic causes include acute tubular necrosis and drug nephrotoxicity. Obstructive uropathy is the cause of postrenal ARF. Patients with ARF have either oliguria or anuria, and, depending on the degree of ARF, may have signs of uremia and electrolyte abnormalities.

Patients should be examined for signs of hypovolemia and have a urinary catheter placed. Indwelling urinary catheters must be irrigated or replaced. If the patient is hypotensive, a fluid bolus is given to determine whether the cause is prerenal. In patients with urinary outlet obstruction, the urinary catheter is both diagnostic and therapeutic. If there is doubt about the cause of the renal failure, central venous pressure and pulmonary capillary wedge pressure measurements can be helpful. The presence of postobstructive uropathy above the urinary bladder can be confirmed using abdominal ultrasound. When no prerenal or postrenal cause can be identified, there is likely to be an intrinsic cause of ARF.

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