Bs Acute Renal Failure

Kidney Function Restoration Program

Most Effective Kidney Disease Treatments

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Richard Sinert

Pathophysiology Clinical Features

Morbidjty/Mortal|tyJromnAcute i Renal .Failure History

Physical ..Examination

Diagnosis Anc.illary.iJest.s


Imaging. Studies


Treatment Disposition

Chapter., References

Acute renal failure (ARF) is defined as a deterioration of renal function over hours or days that results in the accumulation of toxic wastes and the loss of internal homeostasis. Glomerular filtration rate (GFR) is commonly used as an index of renal function, and rapid declines in GFR are viewed synonymously with ARF. Although this concept of ARF is universally accepted, exact definitions of ARF vary in the medical literature. Laboratory scientists, who can directly measure GFR, define ARF as a 50 percent decline in GFR. Clinicians must rely on indirect measures of GFR to define ARF, such as a 50 percent decline in creatinine clearance or a 50 percent increase in serum creatinine from baseline. Finally, some physicians define only those patients requiring dialysis treatment as having ARF. ARF is very common and emergency physicians play a critical role in the early recognition of ARF and prevention of further iatrogenic injury.

ARF is not a disease by itself, but a potential complication of many other disorders (Ta,blĀ§...88.:l). The incidence ARF varies widely, reflecting the study of different patient subsets. In general, a patient's age, volume status, and previous history of renal insufficiency significantly influence the risk of ARF ( Iable..88:2).

TABLE 88-1 Incidence of Acute Renal Failure (ARF) in Selected Settings

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