Causes Of Parenchymatous Acute Renal Failure

Acute tubular necrosis Hemodynamic: cardiovascular surgery,* sepsis,* prerenal causes* Toxic: antimicrobials,* iodide contrast agents,* anesthesics, immunosuppressive or antineoplastic agents,* Chinese herbs, Opiaceous, Extasis, mercurials, organic solvents, venoms, heavy metals, mannitol, radiation Intratubular deposits: acute uric acid nephropathy, myeloma, severe hypercalcemia, primary oxalosis, sulfadiazine, fluoride anesthesics Organic pigments (endogenous nephrotoxins): Myoglobin rhabdomyolisis: muscle trauma; infections; dermatopolymyositis; metabolic alterations; hyperosmolar coma; diabetic ketoacidosis; severe hypokalemia; hyper- or hyponatremia; hypophosphatemia; severe hypothy-roidism; malignant hyperthermia; toxins such as ethylene glycol, carbon monoxide, mercurial chloride, stings; drugs such as fibrates, statins, opioids and amphetamines; hereditary diseases such as muscular dystrophy, metabolopathies, McArdle disease and carnitine deficit Hemoglobinuria: malaria; mechanical destruction of erythrocytes with extracorporeal circulation or metallic prosthesis, transfusion reactions, or other hemolysis; heat stroke; burns; glucose-6-phosphate dehydrogenase; nocturnal paroxystic hemoglobinuria; chemicals such as aniline, quinine, glycerol, benzene, phenol, hydralazine; insect venoms

Acute tubulointerstitial nephritis (see Fig. 8-4)

Vascular occlusion

Principal vessels: bilateral (unilateral in solitary functioning kidney) renal artery thrombosis or embolism, bilateral renal vein thrombosis Small vessels: atheroembolic disease, thrombotic microangiopathy, hemolytic-uremic syndrome or thrombotic thrombocytopenic purpura, postpartum acute renal failure, antiphospholipid syndrome, disseminated intravascular coagulation, scleroderma, malignant arterial hypertension, radiation nephritis, vasculitis

Acute glomerulonephritis Postinfectious: streptococcal or other pathogen associated with visceral abscess, endocarditis, or shunt Henoch-Schonlein purpura Essential mixed cryoglobulinemia Systemic lupus erythematosus ImmunoglobulinA nephropathy Mesangiocapillary

With antiglomerular basement membrane antibodies with lung disease

(Goodpasture is syndrome) or without it Idiopathic, rapidly progressive, without immune deposits

Cortical necrosis, abruptio placentae, septic abortion, disseminated intravascular coagulation

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