Results from a massive insult.
Nephrotoxic
ischemic, either hemodynamic or shock
Progressive rate of rise of sCr
metabolic acidosis, hyperkalemia, hypocalcemia, inc or dec phos
granular or epithelial casts
FeNa >2, UNa >40 mmol/L
Tubule cells die for various reasons, then slough off. The resulting casts can cause obstructions.
Ischemia
endo- and exotoxins
Identify pts at risk
volume status
avoid nephrotoxins
caution with diuretics
rhabdomyolisis/hemolysis
uric acid: allopurinol, HCO3
contrast: prehydration, mucomyst
50% mortality
Oliguric 1-16 weeks, avg 1-2 weeks
diuretic 1-2 weeks
recovery 3-12 months