Acute renal failure: definitions, diagnosis, pathogenesis, and therapy
Robert W. Schrier, … , Brian Poole, Amit Mitra
Robert W. Schrier, … , Brian Poole, Amit Mitra
Published July 1, 2004
Citation Information: J Clin Invest. 2004;114(1):5-14. https://doi.org/10.1172/JCI22353.
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Science in Medicine

Acute renal failure: definitions, diagnosis, pathogenesis, and therapy

Abstract

Acute renal failure (ARF), characterized by sudden loss of the ability of the kidneys to excrete wastes, concentrate urine, conserve electrolytes, and maintain fluid balance, is a frequent clinical problem, particularly in the intensive care unit, where it is associated with a mortality of between 50% and 80%. In this review, the epidemiology and pathophysiology of ARF are discussed, including the vascular, tubular, and inflammatory perturbations. The clinical evaluation of ARF and implications for potential future therapies to decrease the high mortality are described.

Authors

Robert W. Schrier, Wei Wang, Brian Poole, Amit Mitra

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Figure 3

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Following ischemia and reperfusion, morphological changes occur in the p...
Following ischemia and reperfusion, morphological changes occur in the proximal tubules, including loss of polarity, loss of the brush border, and redistribution of integrins and Na+/K+-ATPase to the apical surface. Calcium and reactive oxygen species may also have a role in these morphological changes, in addition to subsequent cell death resulting from necrosis and apoptosis. Both viable and nonviable cells are shed into the tubular lumen, resulting in the formation of casts and luminal obstruction and contributing to the reduction in the GFR. Figure modified with permission from the New England Journal of Medicine (94).