Acute Renal Failure: Medical History

Medical history (history of illness) represents an important component in the diagnosis of acute renal failure (ANV). Family history

Social history

Current anamnesis/systemic anamnesis (somatic and psychological complaints).

  • What complaints have you noticed?
  • How long have these changes existed? Have you been injured?
  • Do you have urinary urgency?
  • How often do you need to urinate each day? When did you last urinate?
  • Do you pass only small amounts of urine when you do so?
  • Has the urine changed in color, consistency and quantity?
  • Do you have any other complaints such as abdominal pain, fatigue, performance slump?
  • Are you drinking enough? How much have you drunk today?

Vegetative anamnesis incl. nutritional anamnesis

  • Has your appetite changed?
  • Have you noticed any unwanted change in weight?
  • Have you noticed any changes in digestion?
  • Do you suffer from sleep disturbances?
  • Do you smoke? If yes, how many cigarettes, cigars or pipes per day?
  • Do you drink alcohol? If yes, what drink(s) and how many glasses per day?
  • Do you use drugs? If yes, what drugs and how often per day or per week?

Self history incl. medication history.

  • Pre-existing conditions
  • Operations
  • Allergies

Medication history

  • ACE inhibitors and AT1- receptor antagonists (acute: decrease in glomerular filtration rate (GFR) associated with creatinine increase:ACE inhibitors as well as AT1 receptor antagonists abolish vasoconstriction in the vas efferens, and a decrease in GFR and increase in serum creatinine result. Up to 0.1 to 0.3 mg/dl, this is usually tolerable.However, in the presence of hemodynamically relevant renal artery stenosis (not uncommon in patients with atherosclerosis/arteriosclerosis), GFR becomes markedly angiotensin II-dependent, and administration of an ACE inhibitor or AT1 receptor antagonist may result in acute renal failure)!
  • Angiotensin receptor neprilysin antagonists (ARNI) – dual drug combination: sacubitril/valsartan.
  • Allopurinol
  • Atypical antipsychotics (olanzapine, quetiapine, risperidone) – elderly patients have approximately 70% increased risk of hospitalization for acute renal failure (ANV) during the first three months of treatment with atypical antipsychotics
  • Antiphlogistic and antipyretic analgesics (non-steroidal anti-inflammatory drugs (NSAID), non-steroidal anti-inflammatory drugs) or non-steroidal anti-inflammatory drugs (NSAID* ) Caution: the combination of a diuretic, an RAS blocker, and an NSAID is associated with a significant risk of acute kidney injury:
    • Acetylsalicylic acid (ASA).
    • Diclofenac
    • Ibuprofen/naproxen
    • Indometacin
    • Metamizole (novaminsulfone) is a pyrazolone derivative and analgesic from the group of non-acidic non-opioid analgesics (highest analgesic and antipyretic activity. Side effects: Circulatory fluctuations, hypersensitivity reactions, and very rarely agranulocytosis.
    • Paracetamol / acetaminophen
    • Phenacetin (phenacetin nephritis)
    • Selective COX-2 inhibitors such as rofecoxib, celecoxib (side effects: decreased sodium and water excretion, blood pressure increase and peripheral edema. This is usually accompanied by hyperkalemia!).
  • Antibiotics
  • Antidiabetics
  • Antifungals
  • Chloral hydrate
  • Colchicine
  • Diuretics
  • D-Penicillamine
  • Gold – sodium aurothiomalate, auranofin
  • Hydroxyethyl starch (HES)
  • Immunosuppressants (ciclosporin (cyclosporin A)) – esp. ciprofloxacin plus ciclosporin A.
  • Interferon
  • Colloidal solution with hydroxyl starch
  • Contrast media – Of particular importance here are magnetic resonance imaging (MRI) contrast media containing gadolinium, which can lead to nephrogenic systemic fibrosis (NSF). Particularly affected by NSF are patients with a glomerular filtration rate (GFR) of less than 30 ml/min. [CKD stage 4]; iodine-containing radiographic contrast agents; [require prophylactic irrigation in renal insufficiency]EMA (European Medicines Agency): categorization of GBCAs (gadolinium-based contrast agents) in terms of NSF (nephrogenic systemic fibrosis) risk, based on thermodynamic and kinetic properties:High risk:
    • Gadoversetamide, gadodiamide (linear/non-ionic chelates) gadopentetate dimeglum (linear/ionic chelate).

    Medium risk:

    • Gadofosveset, gadoxetic acid disodium, gadobenate dimeglumine (linear/ionic chelates).

    Low risk

    • Gadoterate meglumine, gadoteridol, gadobutrol (macrocyclic chelates).
  • Lithium
  • Oncological therapy
  • Proton pump inhibitors (proton pump inhibitors, PPI; acid blockers).
    • “Atherosclerosis Risk in Communities” (ARIC): 10-year PPI use: rate of chronic renal failure in patients on PPI 11.8%, without 8.5%; rate of renal damage: 64%; two pills a day resulted in significantly more frequent damage: 62%
    • Geisinger Health System: observation period 6.2 years; rate of chronic renal failure disease: 17%; rate of renal damage: 31%; two pills a day resulted in significantly more frequent damage: 28%
  • Rast blockers: the combination of a diuretic, an RAS blocker, and an NSAID is associated with a significant risk of acute kidney injury.
  • X-ray contrast agent
  • Statins (rhabdomyolysis)
  • Tacrolism (macrolide derived from the gram-positive bacterium Streptomyces tsukubaensis. Tacrolimus is used as a drug in the group of immunomodulators or calcineurin inhibitors).
  • Antivirals

Environmental history (including intoxications).

  • Aliphatic hydrocarbons (2,2,4-trimethylpentane, decalin, unleaded gasoline, mitomycin C).
  • Ethanol (ethanol; alcohol)
  • Ethylene glycol (ethylene glycol)
  • Halogenated hydrocarbons (HFC; trichloroethene, tetrachloroethene, hexachlorobutadiene, chloroform).
  • Herbicides (paraquat, diquat, chlorinated phenoxyacetic acids).
  • Cocaine
  • Melamine
  • Metals (cadmium, chromium, lead, lithium, nickel, mercury, uranium).
  • Mycotoxins (ochratoxin A, citrinin, aflatoxin B1).
  • Salicylate