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Acute renal failurAcute renal failure in patients with congestive heart failure occurs because of decreased renal blood flow. This decrease is due to hypovolemia from overdiuresis or hypervolemia that causes elevated filling pressures of the left ventricle and leads to decreased cardiac output. Patients in the former group may respond to the discontinuation of diuretics and gentle hydration. Patients in the latter group are treated with diuretics and may need inotropes and vasodilators. Invasive hemodynamic monitoring may be required for fluid management.

The primary agent causeing ARF is ACE CIDPUSA.org

Intrinsic Acute Renal Failure

FIGURE 3. Hyaline and granular casts seen on urine microscopy. (Left) Hyaline casts (arrows). (Right) Granular casts (arrows).

Patients at risk for acute tubular necrosis include those with diabetes, congestive heart failure or chronic renal insufficiency. Acute tubular necrosis may be prevented by promptly treating patients with reversible causes of ischemic or prerenal acute renal failure and by maintaining appropriate hydration in patients who are receiving nephrotoxins.

Once acute tubular necrosis develops, therapy is supportive. Drugs such as mannitol, loop diuretics, dopamine and calcium channel blockers have been somewhat successful in promoting diuresis in animals, but similar results have not been obtained in humans.

TABLE 4 Findings of Blood Tests for Specific Types of Acute Renal Failure Findings on blood tests Diagnoses to consider Elevated uric acid level Suggestive of malignancy or tumor lysis syndrome leading to uric acid crystals; also seen in prerenal acute renal failure Elevated creatine kinase or myoglobin levels Rhabdomyolysis Elevated prostate-specific antigen Prostate cancer Abnormal serum protein electrophoresis Multiple myeloma Low complement levels Systemic lupus erythematosus, postinfectious glomerulonephritis, subacute bacterial endocarditis Positive antineutrophilic cytoplasmic antibody Small-vessel vasculitis (Wegener's granulomatosis or polyarteritis nodosa) Positive antinuclear antibody or antibody to double-stranded DNA Systemic lupus erythematosus Positive antibody to glomerular basement membrane Goodpasture's syndrome Positive antibodies to streptolysin O, streptokinase or hyaluronidase Poststreptococcal glomerulonephritis Schistocytes on peripheral smear, decreased haptoglobin level, elevated lactate dehydrogenase level or elevated serum bilirubin level Hemolytic uremic syndrome or thrombotic thrombocytopenic purpura Low albumin level Liver disease or nephrotic syndrome