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Renal failure, Leads to acute tubular necrosis, can lead to ischemic…

- - - - Major causes:
        
        Ischemia (associated prerenal failure)
        
        Toxic insult (to the tubular structures of nephron)
        
        Intratubular obstruction
  - - - Can occurs:
        
        Ureter (calculi)
        
        Bladder (tumors)
        
        Urethra (prostatic hypertrophy)
      - GFR declines slowly
        
        This is compensated by an increase in tubular pressure:
        
        Increased BUN/Cr ratio > 20
  - - - Impaired perfusion (heart failure, cariogenic shock)
      - Decreased vascular filling (anaphylaxis or sepsis)
      - Depletion of vascular volume (hemorrhage, loss ECF)
    - - Normal cardiac output that kidneys receive = 25%
      - As renal blood flow reduced = GFR and urine output = 0
      - When blood flow falls below the level required to keep renal tubular cells alive = ischemic changes occur
    - - Sharps decrease in urine output
      - Disproportionate elevation of BUN (blood, urea, nitrogen) in relation to serum creatinine levels
  - - - Diagnosis
        
        Identify persons at risk
        
        Observation of urine output
        
        Focus on prevention and early diagnosis
        
        Urinalysis
        
        Blood tests for BUN and creatinine
      - Treatments
        
        Carefully regulate to maintain normal fluid volume and electrolyte concentration
        
        Dialysis
        
        Identify and correct the cause of ARF