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Table 25-2

Etiologies of Acute Kidney Injury in the Intensive Care Unit

PrerenalIntrinsic renalPostrenal (obstructive)
Intravascular volume depletion

  • GI fluid loss (eg, vomiting, diarrhea, EC fistula)

  • Renal fluid loss (eg, diuretics)

  • Burns

  • Blood loss

  • Redistribution of fluid (eg, “third spacing,” pancreatitis, cirrhosis)

Acute tubular necrosis

  • Ischemic

  • Toxin-induced

    • Drugs

    • IV contrast

    • Rhabdomyolysis

    • Massive hemolysis

    • Tumor lysis syndrome

Upper urinary tract obstruction

  • Nephrolithiasis

  • Hematoma

  • Aortic aneurysm

  • Neoplasm

Decreased renal perfusion
pressure

  • Shock (eg, sepsis)

  • Vasodilatory drugs

  • Preglomerular (afferent) arteriolar vasoconstriction

  • Postglomerular (efferent) arteriolar vasodilation

Acute interstitial nephritis

  • Drug induced

  • Infection related

  • Systemic diseases (eg, SLE)

  • Malignancy

Lower urinary tract
obstruction

  • Urethral stricture

  • Hematoma

  • Benign prostatic hypertrophy

  • Neurogenic bladder

  • Malpositioned urethral catheter

  • Neoplasm

Decreased cardiac output

  • Congestive heart failure

  • Myocardial ischemia

Acute glomerulonephritis

  • Postinfectious

  • Systemic vasculitis

  • TTP/HUS

  • Rapidly progressive GN

Vascular

  • Atheroembolic disease

  • Renal artery or vein thrombosis

  • Renal artery dissection

  • Malignant hypertension

Hepatorenal syndrome
Increased intra-abdominal pressure

EC, enterocutaneous; GI, gastrointestinal; GN, glomerulonephritis; HUS, hemolytic uremic syndrome; IV, intravenous; SLE, systemic lupus erythematosus; TTP, thrombotic thrombocytopenic purpura.