1. Prerenal acute renal failure
Since prerenal factors make the effective circulating blood volume decreases renal blood flow, induced renal dysfunction caused by hypoperfusion renal blood flow. Reduced glomerular filtration rate, renal tubular urea nitrogen, water and sodium reabsorption relative increase in blood urea nitrogen patients increased, decreased urine output, specific gravity of urine increased. Prerenal acute renal failure in patients with glomerular and tubular structure remains intact when it returned to normal renal perfusion, glomerular filtration rate also restored. But severe or persistent can prerenal renal hypoperfusion developed acute renal failure with acute tubular necrosis.
(1) Effective hypovolemia: ① Bleeding: trauma, surgery, postpartum, digestive system etc. ② digestive loss, vomiting, diarrhea, gastrointestinal decompression etc. Diuretics ③ missing kidney, diabetic acidosis etc. ④ Loss of skin and mucous membranes, burns, fever etc. ⑤ The third compartment lost crush syndrome, pancreatitis, hyperlipidemia low albumin etc.
(2) Reduction of cardiac output: include congestive heart failure, cardiogenic shock, cardiac tamponade, severe arrhythmia.
(3) Systemic vasodilatation: sepsis, hepatic failure, allergic reactions, drugs (antihypertensive drugs, anesthetics etc.).
(4) Renal vasoconstriction: drug application norepinephrine, hepatorenal syndrome.
(5) Hemodynamic Changes affecting renal drugs: inhibitors of angiotensin converting enzyme, anti-inflammatory drugs.
2. Post-renal acute renal failure
(1) Ureteral obstruction: ① Lock cavity: Crystals (uric acid etc), stones, blood clots etc. ② extraluminal obstruction: The retroperitoneal fibrosis, tumor, hematoma etc.
(2) Bladder neck obstruction: An enlarged prostate, bladder neck fibrosis, neurogenic bladder, prostate cancer etc.
(3) Obstruction urethral stricture etc.
3. Prerenal acute renal failure
(1) Renal tubular disease: Acute tubular necrosis most common. The etiologies include renal ischemia and renal toxicity. ① renal ischemia: prerenal acute renal failure of unknown cause. ② Renal poisoning: Common Toxic renal, such as drugs, contrast agents, heavy metals, biological toxins, organic solvents, myoglobinuria, hemoglobinuria, protein light chain, hypercalcemia etc.
(2) Glomerular Diseases: How rapidly progressive glomerulonephritis, lupus nephritis etc.
(3) Acute interstitial nephritis: acute nephritis (allergic) drug-induced interstitial, sepsis, severe infection, etc.
(4) Renal microvascular disease: necrotizing vasculitis primary or secondary malignant hypertension, kidney damage.
(5) Acute renal macrovascular disease: renal artery thrombosis / renal vein or bilateral or unilateral renal cholesterol crystal embolism, bleeding aneurysm, ruptured renal artery.
(6) Some chronic kidney disease: The worsening of chronic renal failure in promoting factors, leading to chronic renal failure, acute renal failure with acute exacerbation of clinical manifestations.
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