In acute renal failure (ANV; synonyms: acute renal necrosis; acute renal cortical necrosis; acute renal failure with tubular necrosis; acute tubular necrosis; anoxic nephrosis; anoxic tubular necrosis; ANV; bilateral renal cortical necrosis; ischemic nephrosis; cortical renal necrosis; necrotic nephrosis; nephrosis with hemoglobinuria; renal failure with tubular necrosis; renal cortical necrosis; renal tubular necrosis; Renal failure with tubular necrosis; papillary necrosis in nephritis; papillitis necroticans of the kidney; postrenal acute renal failure; prerenal acute renal failure; mercury nephrosis; renal cortical necrosis; renal tubular necrosis; sublimate nephrosis; toxic nephrosis; toxic tubular necrosis; tubular nephrosis of the kidney; tubular necrosis of the kidney; English. acute kidney injury (AKI); ICD-10-GM N17.-: Acute renal failure) is a sudden loss of function of both kidneys (within hours to days). Acute renal failure, unlike chronic renal failure, is potentially reversible. The decisive factor is the treatment of the underlying disease or the elimination of noxious agents (e.g. discontinuation of nephrotoxic drugs/substances). Acute kidney failure occurring or diagnosed in the hospital is referred to as nosocomial acute kidney failure. Acute renal failure can be classified according to its pathophysiology (abnormally altered body functions) as follows:
- Prerenal ANV – in this case, the cause lies before the kidney; the most common form of ANV with 60% of cases.
- Intrarenal ANV – here the cause is in the kidney itself (35% of cases).
- Postrenal ANV – here the cause lies behind the kidney (5% of cases).
The following stages of the disease can be distinguished:
- Initial phase – asymptomatic in relation to the kidney; here the symptomatology of the precipitating underlying disease is in the foreground.
- Manifest renal failure – steady decrease in glomerular filtration rate (GFR) and consequent increase in retention values such as creatinine; may last up to several weeks
- Polyuric phase – recovery of renal function; due to a massive excretion of up to 10 l of urine per day, the water and electrolyte balance is subject to severe fluctuations. This phase is associated with increased mortality (mortality).
Frequency peak: the disease occurs predominantly from the 70th year of life.The prevalence (disease frequency) of acute renal failure for intensive care patients is 5% (in Germany).During hospitalization, 2-18% of hospitalized patients and 22-57% of intensive care patients develop acute kidney injury (AKI).There are few studies on the epidemiology of acute renal failure. A study in Scotland gives an incidence (frequency of new cases) of 1811 cases per 1,000,000 inhabitants per year.Course and prognosis: Acute kidney failure leads to an increase in urinary substances in the blood above normal values (uremia). Furthermore, there are disturbances of the water and electrolyte balance as well as the acid-base balance. Acute kidney failure is usually reversible, i.e. the (approximately) normal function of the kidney returns. The course and prognosis depend on the underlying disease or noxious agent. If the patient has already required dialysis treatment once due to acute kidney failure, the risk of developing progressive chronic kidney failure is increased (especially in the case of intrarenal acute kidney failure). The risk of permanent dialysis treatment depends on the underlying disease and is approximately 5%.In nosocomial acute renal failure, one-third of patients who received machine renal replacement during their intensive care stay continue to require renal replacement after hospital discharge.The lethality (mortality relative to the total number of people with the disease) of intensive care patients with AVN is 60%. This is due to the fact that AVN itself, regardless of the underlying disease, exerts an unfavorable influence on all biological processes and organ functions of the body.
