Failure

Postrenal Failure

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Postrenal Failure, Postrenal Azotemia, Acute Postrenal Failure, Hydronephrosis, Urinary Tract Obstruction, Postrenal Obstruction, Urinary Outflow Obstruction

  • See Also
  1. Acute Kidney Injury
  2. Acute Interstitial Nephritis
  3. Acute Prerenal Failure
  4. Acute Kidney Injury Management
  5. Medication Causes of Acute Kidney Injury
  6. Acute Kidney Injury Causes
  7. Nephrotoxicity Risk
  8. Intravenous Contrast Related Acute Renal Failure
  9. Chronic Renal Failure
  • Epidemiology
  1. Accounts for 1-10% of Acute Renal Failure cases
  2. More common in elderly
  • Pathophysiology
  1. Urinary Tract Obstruction
  2. Results in renal Pelvis dilatation
  3. Progressive decrease in Renal Function
    1. Increased intratubular pressure
    2. Decreased capillary filtration pressure
  • Causes
  1. See Postrenal Failure Causes
  2. See Medication Causes of Postrenal Failure
  • Symptoms
  1. Abdomen or Groin Pain (colic-type attacks)
  • Signs
  1. Mass at flank, suprapubic, or central Abdomen
  2. Abdominal exam
  3. Pelvic exam
  4. Rectal Exam
  5. Anuria (Indicates obstruction in 90% cases)
  • Labs
  1. See Renal Function
  2. Urine Sediment
    1. Normal sediment
    2. Hematuria
    3. Pyuria
    4. Crystals
  • Diagnostic Testing
  1. Post-void residual >100 ml
    1. Indicates Bladder outlet obstruction
  2. Ultrasound or Intravenous Pyelogram
    1. Dilated ureters or renal Pelvis
  3. Abdominal CT or Abdominal MRI
  4. Percutaneous Nephrostomy drainage trial
  • Management
  1. See Acute Kidney Injury Management
  2. Exclude reversible causes rapidly
  3. Renal Function recovery reflects obstruction duration
  • Prognosis
  1. See Acute Kidney Injury Prognosis
  • Prevention
  1. See Prevention of Kidney Disease Progression
  • Resources
  1. Acute Kidney Injury Guidelines
    1. http://www.renal.org/clinical/guidelinessection/AcuteKidneyInjury.aspx
  • References
  1. Anderson (8/15/1993) Hospital Practice, p. 61-75
  2. Meyer (2007) N Engl J Med 357(13): 1316-25 [PubMed]
  3. Rahman (2012) Am Fam Physician 86(7): 631-9 [PubMed]
  4. Singri (2003) JAMA 289(6):747-51 [PubMed]