Failure

Acute Prerenal Failure

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Acute Prerenal Failure, Prerenal Failure, Prerenal Uremia Syndrome

  • Epidemiology
  1. Accounts for 50-70% of all Acute Renal Failure
  • Pathophysiology
  1. Reduced Cardiac Output and renal perfusion pressure (shock states)
  2. Results in afferent arteriole constriction
  3. Avid Sodium and Water reabsorption
  4. Oliguria
  5. Acute Tubular Necrosis if prolonged hypoperfusion
  • Signs
  1. Impaired Cardiac Output
    1. Neck vein distention
    2. Rales
    3. Gallup Rhythm
    4. Pedal edema
  2. Orthostatic Blood Pressure and pulse changes
  3. Weight loss
  4. Decreased fluid intake
  5. Decreased Urine Output
  • Diagnostics
  1. Empiric volume replacement
  2. Invasive cardiac monitoring
  • Labs
  1. See Renal Function
  2. Urine Sediment
    1. Normal sediment
    2. Hyaline Casts
    3. Granular Casts