Acute Renal Failure - Anatomy and Physiology

Allan B. Schwartz, M.D., F.A.C.P.
Disclosures		Relationship: Yes Grants/Research Support: Astella, Sanofi Biomed Honorarium: Speaker's Bureau (Sanofi, Novartis, and OrthoBioTech)

Shiang-Cheng Kung, M.D.
Disclosures		The author has no relationships with commercial interests related to the content of the presentation.

Allan B. Schwartz, MD, is professor of medicine at Drexel University College of Medicine where he is also director of continuing medical education. Shiang-Cheng Kung, MD, is associate professor of medicine, Division of Nephrology and Hypertension at Drexel University College of Medicine. Here, they define acute renal failure ARF) as a rapid decline in glomerular filtration rate (GFR), note that it is generally asymptomatic and usually reversible, and discuss its classification, mechanism, manifestation, and pathophysiology.

The authors define acute renal failure (ARF) as a rapid decline in glomerular filtration rate (GFR) and list three types, one of which, pre-renal acute renal failure, is the commonest cause; it, in turn, is increasingly caused by use of angiotensin-converting-enzyme (ACE) inhibitor in combination with high dose diuretics. They describe the mechanism of action of ACE inhibitors, and NSAIDs, and touch upon the role of the controversial drug rofecoxib (Vioxx) in renal toxicity, a drug which is still the object of litigation and has recently been withdrawn from the market.

Several inflammatory diseases such as glomerulonephritis and noninflammatory ones such as hemolytic uremic syndrome that compromise blood flow may induce acute renal failure (ARF). Most hospital-acquired ARF is due to acute tubular necrosis (ATN) whose pathophysiology the authors discuss in detail, with intrarenal vasoconstriction being its most prominent feature. Among several illustrations accompanying this lecture is a high-power microscopic view of ATN.

The authors go on to describe acute interstitial nephritis and its manifestations and pathogenesis … and continue with a discussion of the clinical presentation and histologic patterns of primary and secondary glomerulonephritis. The lecture concludes with a review of the pathogenesis of renal failure in glomerular disease and the pathophysiology of post-renal acute renal failure.

Note: Part 2 of this lecture covers clinical diagnosis and management of some common causes of acute renal failure.