Acute renal failure is characterized by a deterioration of renalfunction over a period of hours to days, resulting in the failureof the kidney to excrete nitrogenous waste products and to maintainfluid and electrolyte homeostasis. In the past five decades,several important causes of acute renal failure and the pathophysiologicmechanisms that underlie renal dysfunction have come to be understood.In this article we highlight the epidemiology, general causes,and evaluation of acute renal failure in adults. We then expandon the pathophysiology of ischemic acute renal failure and discussthe rationale for both current and future therapies. . . . [Full Text of this Article]
Background and Epidemiology
Causes of Acute Renal Failure
Prerenal Causes
Postrenal Causes
Intrinsic Causes
Risk Factors, Morbidity, and Mortality
Diagnostic Evaluation
History Taking and Physical Examination
Urine Evaluation
Blood Tests
Evaluation of Obstruction
Role of Renal Biopsy in Acute Renal Failure
Pathophysiology of Ischemic Acute Renal Failure and Rationale for Therapies
Vascular Factors and Therapy with Vasodilators
Dopamine
Calcium-Channel Blockers
Natriuretic Peptides
Medullary Hypoxia
Tubular-Cell Injury
Structural Changes
Osmotic Agents and Diuretics
Biochemical Changes
Calcium
Reactive oxygen species
Purine depletion
Phospholipases
Apoptosis
Acute Renal Failure in Transplant Recipients
Role of Growth Factors in Recovery from Ischemic Acute Renal Failure
Management of Acute Renal Failure
General Principles
Replacement Therapy
Source Information
From the Department of Medicine and Renal Unit (R.T., M.P., J.V.B.) and the Transplantation Unit (M.P.), Massachusetts General Hospital and Harvard Medical School; and the Harvard–Massachusetts Institute of Technology Division of Health Sciences and Technology (J.V.B.) — all in Boston.
Address reprint requests to Dr. Bonventre at Suite 4002, 149 13th St., Charlestown, MA 02129.
References
Related Letters:
Acute Renal Failure
Lindner A., Sherrard D. J., Friedman E. A., Glaser D. S., Thadhani R., Pascual M., Bonventre J. V.
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N Engl J Med 1996;
335:1320-1322, Oct 24, 1996.
Correspondence
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(2004). Amelioration of Ischemic Acute Renal Injury by Neutrophil Gelatinase-Associated Lipocalin. J. Am. Soc. Nephrol.
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de Vries, B., Walter, S. J., Peutz-Kootstra, C. J., Wolfs, T. G.A.M., van Heurn, L.W. E., Buurman, W. A.
(2004). The Mannose-Binding Lectin-Pathway Is Involved in Complement Activation in the Course of Renal Ischemia-Reperfusion Injury. Am. J. Pathol.
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Pingle, S. C., Mishra, S., Marcuzzi, A., Bhat, S. G., Sekino, Y., Rybak, L. P., Ramkumar, V.
(2004). Osmotic Diuretics Induce Adenosine A1 Receptor Expression and Protect Renal Proximal Tubular Epithelial Cells against Cisplatin-mediated Apoptosis. J. Biol. Chem.
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Lins, R. L., Elseviers, M. M., Daelemans, R., Arnouts, P., Billiouw, J.-M., Couttenye, M., Gheuens, E., Rogiers, P., Rutsaert, R., Van der Niepen, P., De Broe, M. E.
(2004). Re-evaluation and modification of the Stuivenberg Hospital Acute Renal Failure (SHARF) scoring system for the prognosis of acute renal failure: an independent multicentre, prospective study. Nephrol Dial Transplant
19: 2282-2288
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Himmelfarb, J., McMonagle, E., Freedman, S., Klenzak, J., McMenamin, E., Le, P., Pupim, L. B., Ikizler, T. A., The PICARD Group,
(2004). Oxidative Stress Is Increased in Critically Ill Patients with Acute Renal Failure. J. Am. Soc. Nephrol.
15: 2449-2456
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Morigi, M., Imberti, B., Zoja, C., Corna, D., Tomasoni, S., Abbate, M., Rottoli, D., Angioletti, S., Benigni, A., Perico, N., Alison, M., Remuzzi, G.
(2004). Mesenchymal Stem Cells Are Renotropic, Helping to Repair the Kidney and Improve Function in Acute Renal Failure. J. Am. Soc. Nephrol.
15: 1794-1804
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Zhang, Y., Woodward, V. K., Shelton, J. M., Richardson, J. A., Zhou, X. J., Link, D., Kielar, M. L., Jeyarajah, D. R., Lu, C. Y.
(2004). Ischemia-reperfusion induces G-CSF gene expression by renal medullary thick ascending limb cells in vivo and in vitro. Am. J. Physiol. Renal Physiol.
286: F1193-F1201
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Zeisberg, M., Muller, G. A., Kalluri, R.
(2004). Are there endogenous molecules that protect kidneys from injury? The case for bone morphogenic protein-7 (BMP-7). Nephrol Dial Transplant
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Yamada, K., Miwa, T., Liu, J., Nangaku, M., Song, W.-C.
(2004). Critical Protection from Renal Ischemia Reperfusion Injury by CD55 and CD59. J. Immunol.
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Costa, J., Crausman, R. S., Weinberg, M. S.
(2004). Acute and Chronic Renal Failure. J. Am. Podiatr. Med. Assoc.
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Ichimura, T., Hung, C. C., Yang, S. A., Stevens, J. L., Bonventre, J. V.
(2004). Kidney injury molecule-1: a tissue and urinary biomarker for nephrotoxicant-induced renal injury. Am. J. Physiol. Renal Physiol.
286: F552-F563
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Silva, F. G.
(2004). Chemical-Induced Nephropathy: A Review of the Renal Tubulointerstitial Lesions in Humans. Toxicol Pathol
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[Abstract]
Higuchi, T., Orita, T., Nakanishi, S., Katsuya, K., Watanabe, H., Yamasaki, Y., Waga, I., Nanayama, T., Yamamoto, Y., Munger, W., Sun, H.-W., Falk, R. J., Jennette, J. C., Alcorta, D. A., Li, H., Yamamoto, T., Saito, Y., Nakamura, M.
(2004). Molecular Cloning, Genomic Structure, and Expression Analysis of MUC20, a Novel Mucin Protein, Up-regulated in Injured Kidney. J. Biol. Chem.
279: 1968-1979
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Fiaschi-Taesch, N. M., Santos, S., Reddy, V., Van Why, S. K., Philbrick, W. F., Ortega, A., Esbrit, P., Orloff, J. J., Garcia-Ocana, A.
(2004). Prevention of Acute Ischemic Renal Failure by Targeted Delivery of Growth Factors to the Proximal Tubule in Transgenic Mice: The Efficacy of Parathyroid Hormone-Related Protein and Hepatocyte Growth Factor. J. Am. Soc. Nephrol.
15: 112-125
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Cybulsky, A. V., Takano, T., Papillon, J., Khadir, A., Bijian, K., Chien, C.-C., Alpers, C. E., Rabb, H.
(2004). Renal expression and activity of the germinal center kinase SK2. Am. J. Physiol. Renal Physiol.
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Lin, F., Igarashi, P.
(2003). Searching for Stem/Progenitor Cells in the Adult Mouse Kidney. J. Am. Soc. Nephrol.
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Mishra, J., Ma, Q., Prada, A., Mitsnefes, M., Zahedi, K., Yang, J., Barasch, J., Devarajan, P.
(2003). Identification of Neutrophil Gelatinase-Associated Lipocalin as a Novel Early Urinary Biomarker for Ischemic Renal Injury. J. Am. Soc. Nephrol.
14: 2534-2543
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Burne-Taney, M. J., Ascon, D. B., Daniels, F., Racusen, L., Baldwin, W., Rabb, H.
(2003). B Cell Deficiency Confers Protection from Renal Ischemia Reperfusion Injury. J. Immunol.
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Okusa, M. D., Ye, H., Huang, L., Sigismund, L., Macdonald, T., Lynch, K. R.
(2003). Selective blockade of lysophosphatidic acid LPA3 receptors reduces murine renal ischemia-reperfusion injury. Am. J. Physiol. Renal Physiol.
285: F565-F574
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SALOMON, L., DERAY, G., JAUDON, M. C., CHEBASSIER, C., BOSSI, P., LAUNAY-VACHER, V., DIQUET, B., CEZA, J. M., LEVU, S., BRUCKER, G., RAVAUD, P.
(2003). Medication misuse in hospitalized patients with renal impairment. Int J Qual Health Care
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