Prerenal |
Cardiac output↓ |
Acute myocardial infarction, valve rupture, acute pericarditis, acute myocarditis Drugs exacerbate heart failure (COX inhibitors, CCB, TZD, DPP-4i) Drugs cause direct heart injury (rheumatologic agents (e.g., TNF-α inhibitors), anthracyclines, taxanes, targeted therapy (e.g., bevacizumab, sorafenib), anti-Parkinson (Pergolide, Pramipexole) |
History: fever, vomiting, diarrhea, chest pain, orthopnea, palpitation, urine output↓, liver/CV diseases Drug: diuretics, NSAID Physical exam: BP↓/HR↑, skin turgor/mucosa, edema |
True hypovolemia |
Renal loss (diuretics, osmotic diuresis); Extrarenal loss (diarrhea, hemorrhage, burn, third spacing) |
Effective volume↓ |
Sepsis, neurogenic shock, anaphylaxis |
Intrarenal vasoconstriction |
Hypercalcemia, hepatorenal syndrome, drugs (CNIs, NSAID, vasoconstrictors.) |
Intrinsic |
Glomerular injury |
Nephrotic (MCD, MPGN, drugs (NSAID, gold, penicillamine))213607Nephritic (IRGN, lupus nephritis, AAV, anti-GBM disease, IgAN, drugs (e.g., hydralazine)) |
History: Fever, cellulitis, URI, flank pain, foamy urine, urine output↓, myalgia, hemoptysis Drug: antibiotics, NSAID, statin, contrast Physical exam: BP, Skin rash, arthritis |
Tubular injury |
Severe prerenal causes, toxins (endogenous: hemolysis, rhabdomyolysis, tumor lysis syndrome) or exogenous (aminoglycoside, contrast, CNIs, acyclovir, lithium, vancomycin)) |
Interstitial injury |
Allergy (drug: cephalosporin, penicillin, PPI, NSAID, herbs); Infection (bacteria, fungus, virus, leptospirosis); Autoimmune (Lupus, anti-TBM disease, AAV) |
Vascular injury |
Small caliber (TMA (malignant hypertension, HUS/TTP, DIC), scleroderma renal crisis) Large caliber (renal infarction, renal vein thrombosis) |
Postrenal |
Urinary tract |
Benign prostatic hyperplasia; neurogenic bladder; Intra-ureter (stones, tumors); Extraureter (retroperitoneal fibrosis, intra-abdominal tumors) lesions |
History: low urinary tract symptoms, gross hematuria Physical exam: suprapubic tenderness, abdomen mass Image: e.g., ultrasound |
Intrarenal |
Crystals (acyclovir, indinavir), stones, tumors, paraproteins (myeloma) |