| [ Summary ] |
Acute renal failure (ARF) is a syndrome characterized by a rapid decline in the glomerular filtration rate. ARF is divided into three categories : pre-renal, renal and post-renal. Post-renal ARF is easily diagnosed by ultrasonography and other imaging manuevers, and is treated surgically, such as with ureteral drainage. When pre-renal and post-renal ARF have been excluded, renal biopsy is useful for diagnosing the etiology of renal ARF, that may be responsive to specific therapy. The term acute tubular necrosis (ATN) is commonly used to denote ischemic or nephrotoxic ARF in clinical practice. The mechanisms of ischemic renal epithelial cell damage include the depletion of intracellular ATP as the central phenomenon, followed by an increase in the intracellular calcium concentration, intracellular acidosis, and activation of reactive oxygen stress. These phenomena induce intracellular electrolyte imbalances, destruction of the cytoskeleton and the activation of phospholipases and proteases, resulting in renal epithelial cell death, which establishes acute tubular necrosis. |