Day #17 - Renal Failure

Today we talked about the approach to renal failure. It is easiest to conceptualize etiology and treatment using the pre-renal, renal, and post-renal framework which I will summarize. I have also included some great articles about a few of these conditions below.

Pre-Renal:

• Hypotension
• Hypovolemia
• Decreased ECF states - CHF, cirrhosis, bilateral renal artery stenosis

Renal:

• TTP/HUS
  
• Acute Tubular Necrosis (ATN) -- Toxic/Ischemic injury (contrast, aminoglycosides, prolonged hypotension)
  
• Acute Interstitial Nephritis (AIN) -- Drugs (i.e. penicillins, NSAIDS)
  Don't rely on urine eosinophils to make this diagnosis
  
• Glomerulonephritis (includes renal vasculitis)
  
• Nephrotic Syndrome
  

Post-Renal:

• Obstructing stones/masses
• Urinary outflow obstruction -- i.e. prostate, neurogenic bladder
  

Treatment:
Pre-Renal --> Treat hypotension and hypovolemia. Treat CHF.
Post-Renal --> Relieve the obstruction. Watch for post-obstructive diuresis and treat it appropriately.

Renal --> Stop the precipitant if there is one. Treatment is otherwise context dependent.

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FYI the article on the "digoxin soup" is here.