Intrinsic Acute Renal Failure
| Overview |
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- Intrinsic Acute Renal Faliure (ARF) is a generic subcategorization of pathogenic mechanisms by which ARF may develop. It is defined by the development of ARF due to dysfunntion of processes within the kidney itself. The clinical consequences of intrinsic ARF are common to all sources of acute renal failure and are described in the Acute Renal Failure page.
| Pathogenesis |
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- The pathogenesis of Instrinsic ARF depends on the particular etiology. Whatever the insult, the result is a precipitous (hours to days) decline in the Glomerular Filtration Rate (GFR) thus necessitating diagnosis of ARF.
| Etiologies |
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- Vascular Disease
- Showers of thromboemboli from an atherosclerotic plaque into the branches of the renal arterial supply can precipitously reduce perfusion of downstream glomeruli, thus yielding a sudden drop in GFR. In reality this pathogenic mechanism is analogous to those of Prerenal ARF; however, the source of reduced glomerular perfusion is mechanical blockage of the renal arterial supply itself.
- Glomerular Disease
- Acute inflammation of glomeruli, generically termed acute glomerulonephritis, can suddenly reduce the level of GFR. Acute glomerulonephritis can be caused by many of the etiologies discussed under glomerular pathology, especially those causing nephritic syndrome.
- Tubulointerstitial Disease
- The vast majority of ARF cases are caused by acute tubular necrosis, either due to ischemic or nephrotoxic etiologies. Finally, acute drug-induced interstitial nephritis can precipitate intrinsic ARF.