Topics in Renal Disease – serie

Renal function fails abruptly in a bewildering variety of clinical situations which lack any common clinical patterno This makes it impossible to define acute renal failure in the same way as heart failure or liver failureo Even oliguria, the commonest sign, is not invariably present. As a result, the detection of acute renal failure Table 1. Causes of acute renal failureo Acute tubular necrosis Ischaemic type Nephrotoxic type Cortical necrosi . * Hepatorenal syndrome Occlusion of main renal arteries Occlusion of arterioles Malignant hypertension Haemolytic uraemic syndrome Thrombotic thrombocytopenic purpura Postpartum nephrosclerosis Acute glomerulonephritis Post-streptococcal 'Crescentic' nephritis } do thO th t dO Necrotizing glomerulitis I IOpa IC WI sys emlc Iseases Renal vein thrombosis Obstruction U ric acid crystals Stones Tumours-benign and malignant Fibrosis Strictures 2 Acute and Chronic Renal Failure (ARF) depends on biochemical tests, which are fortunately simple to perform and are commonly available. However, the clinician has to think of the possibility in order to test the diagnosis.Frequently, patients are admitted to a renal unit from medical, surgical or gynaecological wards where the development of ARF has gone unrecognized, either because the relevant investigation has not been performed or because the result has been overlooked. This happens because ARF occurs in patients with complex problems which themselves demand con- siderable attention, and it is easy to overlook a comparatively rare, if important, complication.

This book does not pretend to be a comprehensive textbook of nephrology, nor is it a guide to the management of renal disease, as space does not allow the description or discus­ sion of investigation and treatment. Its intention is to illustrate the diverse diseases which present to nephrologists. Since the key to understanding the effects and progression of a disease are to know and com­ prehend its pathology, I have approached the subject not by discussing presenting symptoms of single diseases in different sections, which would lead to much repetition, but by describing the disorders according to the mechanisms which cause them. To illustrate the text I have chosen the most immediate clue which usually appears in a given dis­ ease, which may therefore be a clinical sign, a radiograph or the histological appearance of a renal biopsy. D. Gwyn Williams Guy's Hospital, London 1. Trauma Trauma is a common cause of acute renal failure. This may arise directly from injuries to the kidneys themselves despite their protected position (Figure 1). Trauma can also cause acute renal failure by damaging the renal arteries, which may be actually avulsed from the kidneys, or stretched at the time of impact, with tearing of the arterial wall and secondary thrombosis. Figure 2 shows the renal arteriogram of a young man who presented with anuric acute renal failure after a motorbike accident. Only the upper pole of the right kidney is Figure 1.