The most common causes of acute renal failure of renal origin include acute or rapidly progressive glomerulonephritis, acute interstitial nephritis, and toxic nephropathy.

bubble_chart Clinical Manifestations

Symptoms and signs: Patients usually have a history of pharyngitis or upper respiratory tract infection, have used antibiotics or other nephrotoxic drugs, and may occasionally experience bilateral lumbago, even severe pain, and may have gross hematuria.

Acute renal failure caused by pyelonephritis is rare, unless combined with the following conditions: ① sepsis or dehydration; ② urinary tract obstruction; ③ solitary kidney.

Systemic diseases that cause acute renal failure include: Henoch-Schonlein purpura, thrombotic thrombocytopenic purpura, systemic lupus erythematosus, and scleroderma. Human immunodeficiency virus (HIV) infection can lead to HIV nephropathy, which may present as acute renal failure, and the prognosis for patients is extremely poor.

bubble_chart Auxiliary Examination

Laboratory Examination:

①Urine: Microscopic examination reveals a large number of red blood cells, white blood cells, and various cellular or granular casts. Eosinophils may be seen in the urine of patients with allergic interstitial nephritis. Urinary sodium concentration is 10-40 meq/L.

②Blood: During the deposition of immune complexes, the moistening and tonifying components of the blood decrease. Under certain conditions, circulating immune complexes can be detected. Other tests may reveal systemic diseases such as lupus erythematosus and thrombotic thrombocytopenic purpura.

③Renal Biopsy: Renal biopsy will show the characteristic pathological changes of acute interstitial nephritis or glomerulonephritis. Widespread crescent formation can be seen within the glomerular capsule.

Intravenous urography or isotope renal scanning may show poor imaging. Because contrast agents have nephrotoxic effects, routine intravenous urography should be avoided. Ultrasound is the best method to exclude urinary tract obstruction.

bubble_chart Treatment Measures

The principles of treatment are: controlling infection, eliminating antigens and toxic drugs, suppressing immune responses, removing autoimmune antibodies, or reducing inflammatory responses. Immunotherapy includes medications, anticoagulation, or temporary plasma exchange therapy.