Aeitology of Renal Failure in ICU

The classical compartmentalisation of pre-renal, intra-renal and post-renal factors holds true in the intensive care unit with the following considerations:


  • A missed, but reversible, cause of renal failure has dire consequences.

  • Renal perfusion (blood flow and GFR) in critically ill patients may become directly related to systemic blood pressure as local auto regulation fails.  Hypotension, even a marginal decrease, will not be well tolerated.

  • The renal interstitium is relatively hypoxic even under optimal conditions.  When subjected to a multilevel endothelial insult as a result of sepsis or SIRS there is a predisposition to a vasomotor nephropathy and progression to overt ATN.

  • The pharmacokinetics of many drugs in intensive care are severely deranged, exposing the patient to a much greater risk of nephrotoxic effects.  Drugs and toxins (including radio-contrast) should not be administered without consideration of their toxicity.

  • Occult or overt increases in intra-abdominal pressure should always be considered in patients with abdominal distension with or without previous surgery.  When considered it should be measured and if necessary addressed.


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Page last reviewed: 13 May 2014