Renal failure, acute etiology

In many cases of severe hepatotoxicity, renal injury is also present and may range from oliguria to acute renal failure. The etiology of the renal injury may be a direct effect of a toxic metabolite of acetaminophen, M-acetyl-p-benzoquinone-imine (discussed in the next section), generated by renal cytochrome oxidase or a consequence of hepatic injury resulting in hepatorenal syndrome. Isolated cases of myocardial injury have been reported rarely. ... 

Fig. 62. SDS-PAGE in normal controls and in patients with myoglobinuric acute renal failure, ALPE, or acute renal failure related to other etiologies. There were no bands which were specific to ALPE. ARF, acute renal failure (p. 68)...

In the first patient and the fourth patient in our initial series (p. 7), the association of ALPE with anaerobic exercise had not yet been recognized, and their medical histories may have been insufficient, or the patients may not have reported intense exercise over a short duration. In acute renal failure patients with loin pain of unknown etiology, the presence or absence of anaerobic exercise should always be ascertained when taking their medical history. Erley et al. [28] did not comment on exercise in their study. However, when Sato et al. inquired about exercise in 1998 [34], Erley et al. reported that the patient had undertaken exercise. 

This patient was the first case in our series in which ALPE was detected with acute renal failure due to unknown etiology. On September 19,1976, he ran two 100-m races at an athletics meeting. On September 20, vomiting, diarrhea, and upper abdominal pain developed, and the patient attended our department. His serum creatinine and uric acid levels were 5.0 mg/dl and 17.0 mg/dl, respectively. The pain persisted for 1... 

Methods of preventing exercise-induced acute renal failure (ALPE) and relapse have not been established as the etiology and pathogenesis of ALPE remain to be clarified. However, the following points are important. 

Yoshida M, Yagi N, Miyazato H, Sakuda A, Sunagawa H, Uehara G (2005) A case of hypouricemia of unknown etiology with exercise-induced acute renal failure (Japanese abstract). J Okinawa Med Assoc 44 129... 

Traditionally, when searching for the etiology of AKI, the clinician s will subdivides the potential causes of a sudden decline of GFR into one of three general pathophysiologic processes pre renal failure, intrarenal failure or post renal failure [1]. Recently, Miet et al [ 52] in discussing drug-induce acute kidney injury detailed two additional mechanisms that need to be considered in addition to those outlined in Table 2. 

SelCuk NY, Odabas AR, Cetinkaya R, Tonbul FIZ, and San A. 2000. Frequency and outcome of patients with acute renal failure have more causes than one in etiology. Ren Fail 22 459-464. 

Behrend T, and Miller SB. 1999. Acute renal failure in the cardiac care unit etiologies, outcomes, and prognostic factors. Kidney... 

Sural S, Sharma RK, Singhal M, et al. Etiology, prognosis, and outcome of post-operative acute renal failure. Ren Fail 2000 22 87-97. 

Drugs are an infrequent cause of community-acquired acute renal failure (ARF). However, drugs share the spotlight with renal hypoxia as the leading etiologic factors for hospital acquired ARF [1,... 

In studies of the etiology of acute renal failure, medication-induced renal injury is reported as a major cause. In an analysis of over 2000 hospitalized patients, almost 100 experienced renal insufficiency and seven episodes were attributed solely to aminoglycoside therapy [11]. A high percentage of neonatal patients are treated with aminoglycosides and in the involvement of drugs in neonatal acute renal failure has increased up to 8-fold in the last 10 years [12]. 

Several patients have also been reported with acute renal failure attributed to ritonavir [126-129]. Most of these patients were on other potentially nephrotoxic medications, and some had volume depletion or preexisting kidney disease. In several patients, ARF recurred upon rechallenge with ritonavir. None of the patients had renal biopsies performed, so there is no information on the histopafhologic correlates and etiology of the renal failure. 

In some patients the etiology of the acute renal failure may relate to isometric tension in restrained hmbs, and in others to ischemic damage to muscle in the presence of hyperthermia and/or hmb compression [144, 149]. While it is possible that the drug itself may possess direct myopathic toxicity when abused in certain settings, it does not induce rhabdomyolysis in unrestrained animals [150]. Animals restrained in immobi-... 

This region has two major referral hospitals for treating those people in renal failure. It is our opinion that in the majority of toxin induced acute renal failure unknown toxin is by far the commonest etiological agent In a minority of cases the definite agent is know. One of these is potassium dichromate. The excellent work done by Wood et al [3] in describing the extent of the toxicity of potassium dichromate has been of great educational value. 

Table 19.1. The most common causes of acute renal failure with regard to the major pathogenetic mechanisms perirenal causes, intrinsic renal failure and postrenal etiology (modified from Andreoli 1999)...

Stapleton FB, Jones DP, Green RS (1987) Acute renal failure in neonates incidence, etiology and outcome. Pediatr Nephrol 1 314-320... 

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