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Skip to 0 minutes and 11 seconds And so those patient by urine outputs can actually find a patient with different three kinds. So the first one is a pre-renal azotemia and other intrinsic renal failure and the other the rest is post-renal obstruction. And for patient with a pre-renal azotemia is a counts for about 35% of a total patients with ARF. And the patient actually has a secondary cause and pay to have a diminished renal blood flow. So usually this kind of a patient they don’t have real damage at their renal. It just because the patient has decreased renal blood flow. So the patient develop those signs and symptoms of ARF. And after a reverse there renal blood flow and they actually can quickly reverse the ARF.

Skip to 1 minute and 24 seconds And for those who with an intrinsic renal value a kinds for sixty percent of a total patient with ARF. They have a truly renal tissue damage so the recovery is actually very slow and depends on the underline disease. And post-renal obstruction that’s actually has an obstruction in their urinary tract. So after removing the reason of obstruction the patient also can recover quickly. Pre-renal azotemia we has many different reasons. The first is the patient with reduced cardiac output so for those who has congestive heart failure or MI, acute pulmonary embolism, cardiomyopathy those patient with reduce cardiac output they were actually has a decreased renal blood flow. So that’s cause pre-renal azotemia.

Skip to 2 minutes and 34 seconds And also there are a lots of a different reason with hypovolemia: trauma, burn, hemorrhage. Now, these are the reason also cause pre-renal azotemia. And some patient may have renal vascular resistance. So those blood couldn’t get into their renal vascular system. So those who has renovascular obstruction, systemic vasodilation. Or some with the surgery they will actually have a pre-renal azotemia. And so for those who had a systemic vasodilation the same they will have a pre-renal azotemia. Or some patient has renal vascular obstruction the same they could have a signs and symptom of a pre-renal azotemia. And for those intrinsic renal failure patient, they actually has truly renal cell damage.

Skip to 3 minutes and 41 seconds And it also could actually occur in a patient with the prolonged pre-renal azotemia. And after the pre-renal azotemia we has a very instance of time the patient will finally develop their renal tissue damage. And for a lot of a nephrotoxic drugs they may actually has direct damage to renal cell and could cause intrinsic renal failure. And for those who has renal ischemic events or we assign infection in renal such as glomerulonephritis or tubulointerstitial diseases they could have an intrinsic renal failure. And for post-renal ARF can acturally from some bladder obstruction, ureteral obstruction or urethral obstruction. So those could from those blood clot or cancer or some crystal from the urinary tract.

Skip to 4 minutes and 55 seconds and so those issue need to be resolved before their ARF could be treated.

Classification of Acute Renal Failure

In this step, Prof. Chen illustrates the classification of ARF, including pre-renal azotemia, intrinsic renal failure, and post-renal obstruction.

To begin with, there are plenty of symptoms for pre-renal azotemia, including reduced cardiac output, hypovolemia, and increased renal vascular resistance.

For those patients with intrinsic renal failure, they have renal cell damage, which could occur with prolonged pre-renal azotemia for those who have renal ischemic events.

Besides, patients with renal infection such as glomerulonephritis or tubulointerstitial diseases could have an intrinsic renal failure.

Finally, post-renal ARF can come from bladder obstruction, ureteral obstruction or urethral obstruction. Thus, these issues need to be resolved before the ARF could be treated.

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Pharmacokinetics: Drug Dosing in Renal Disease

Taipei Medical University