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Acute renal failure. 1. Classification, evaluation, and clinical consequences

H R Harter, K J Martin

    Postgraduate Medicine
    |December 1, 1982
    PubMed
    Summary
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    Urinalysis and urine chemistries help identify causes of acute renal failure. When prerenal and postrenal factors are ruled out, acute tubular necrosis is suspected, presenting distinct clinical phases and systemic effects.

    Area of Science:

    • Nephrology
    • Internal Medicine
    • Diagnostic Imaging

    Background:

    • Acute renal failure (ARF) diagnosis relies on differentiating prerenal, renal, and postrenal etiologies.
    • Early identification of ARF causes is crucial for timely intervention and management.
    • Understanding the phases of acute tubular necrosis (ATN) is key to patient care.

    Purpose of the Study:

    • To outline the diagnostic approach to acute renal failure.
    • To describe the progression and clinical manifestations of acute tubular necrosis.
    • To emphasize the role of urinalysis, urine chemistries, and imaging in diagnosing renal failure.

    Main Methods:

    • Utilizing urinalysis and urine chemistries to assess renal function.
    • Employing abdominal radiography, ultrasound, and computed tomography for obstruction evaluation.

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  • Clinical observation to delineate the phases of acute tubular necrosis (initiating, oliguric, diuretic, recovery).

    • Main Results:

    • Urinalysis and urine chemistries effectively distinguish prerenal, renal, and postrenal causes of ARF.
    • Imaging modalities like ultrasound and CT are vital when obstruction is suspected.
    • Exclusion of prerenal and postrenal causes points towards acute tubular necrosis as the likely diagnosis.

    Conclusions:

    • Acute tubular necrosis is the presumed cause of renal failure when other causes are excluded.
    • ATN progresses through identifiable phases, each with characteristic clinical features.
    • ATN can lead to widespread systemic complications, including electrolyte imbalances, acidosis, anemia, and infections.