Acute tubular necrosis (ATN) secondary to renal ischemia accounts for the majority of cases of intrinsic renal failure. Nephrotoxins are the second most common cause of ATN, accounting for approximately 25 percent. When the etiologies of ARF were reviewed in a multivariate analysis, a synergistic effect was noted for the combination of ischemic and nephrotoxic ATN.11
Postrenal failure accounts for 2 to 5 percent of all cases of ARF, but has a significantly higher incidence in selected populations ( Table.88.-5). In large surveys of elderly men for symptoms of urinary obstruction, prevalence between 20 to 35 percent has been estimated.12 In young males, renal calculi are the most common cause of obstruction. In young females, cervical carcinoma can cause urinary obstruction. In children, postrenal failure is commonly secondary to congenital malformations such as urethral valves in boys and vesicoureteral reflux in girls.
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