Causes

Pre-renal causes ^c

• cardiogenic shock e.g. hypotension from MI, heart failure
• hypovolaemia e.g. dehydration, haemorrhage, surgery
• sepsis
• liver failure

• acute tubular necrosis due to ischaemia (i.e. any pre-renal cause if sufficiently severe or prolonged)
• acute tubular necrosis due to drugs or toxins (e.g. aminoglycosides, contrast media)
• acute interstitial nephritis
• vasculitis, atheroemboli, glomerulonephritis, myeloma, scleroderma, and malignant hypertension

• obstruction (stones, prostate, tumour)

Note:

Acute tubular necrosis and prerenal failure are the commonest causes of acute renal failure

Causes of acute renal failure	% (95% CI)
acute tubular necrosis	45% (41% to 49%)
pre-renal	21% (18% to 24%)
acute onset chronic renal failure	13% (10% to 15%)
obstruction (stones, prostate, tumour)	10% (7.9% to 12%)
acute tubulointerstitial nephritis	2.0% (1.0% to 3.0%)
secondary glomerulonephritis	1.6% (0.7% to 2.5%)
primary glomerulonephritis	1.5% (0.6% to 2.3%)
vasculitis	1.5% (0.6% to 2.3%)
vascular (atheroembolic or thrombosis)	1.1% (0.3% to 1.8%)
other or unknown	3.5% (2.2% to 4.8%)

Causes of in-hospital acute renal failure	% (95% CI)
decreased renal perfusion	42% (33% to 50%)
major surgery	18% (11% to 24%)
contrast media administration	12% (6.7% to 18%)
aminoglycoside administration	7.0% (2.6% to 11%)
hepatorenal syndrome	3.9% (0.5% to 7.2%)
multifactorial	3.1% (0.1% to 6.1%)
obstruction	2.3% (0.0% to 4.9%)
vasculitis	1.6% (0.0% to 3.7%)
other or unknown	11% (5.5% to 16%)

Causes of acute tubular necrosis	% (95% CI)
hypotension	63% (55% to 71%)
multifactorial	62% (54% to 70%)
dehydration	29% (22% to 37%)
sepsis	26% (19% to 33%)
pigmenturia	19% (12% to 25%)
aminoglycoside use	10% (5.0% to 16%)
radiocontrast	10% (5.0% to 16%)
liver disease	2.1% (0.0% to 4.4%)