Kidney failure can occur from an acute situation or from chronic problems.
In acute renal failure, kidney function is lost rapidly and can occur from a variety of insults to the body. The list of causes is often categorized based on where the injury has occurred.
Prerenal causes are due to decreased blood supply to the kidney. Examples of prerenal causes are:
- Hypovolemia (low blood volume) due to blood loss.
- Dehydration from loss of body fluid (vomiting, diarrhea, sweating, fever).
- Poor intake of fluids.
- Medication, for example, diuretics (water pills) may cause excessive water loss.
- Loss of blood supply to the kidney due to obstruction of the renal artery or vein.
Renal causes (damage directly to the kidney itself) include:
- Sepsis: The body's immune system is overwhelmed from infection and causes inflammation and shutdown of the kidneys. This usually does not occur with urinary tract infections.
- Medications: Some medications are toxic to the kidney, including nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen. Others are antibiotics like aminoglycosides (gentamicin, tobramycin), lithium (Eskalith, Lithobid), iodine-containing medications such as those injected for radiology dye studies.
- Rhabdomyolysis: This is a situation in which there is significant muscle breakdown in the body, and the degeneration products of muscle fibers clog the filtering system of the kidneys. Often occurring because of trauma and crush injuries, it can also be caused by some medications used to treat high cholesterol.
- Multiple Myeloma.
- Acute glomerulonephritis or inflammation of the glomeruli, the filtering system of the kidneys. Many diseases can cause this inflammation including systemic lupus erythematosus, Wegener's granulomatosis, and Goodpasture syndrome.
Post-renal causes are due to factors that affect outflow of the urine:
- Obstruction of the bladder or the ureters can cause back pressure when there is no place for the urine to go as the kidneys continue to work. When the pressure increases enough, the kidneys shut down.
- Prostatic hypertrophy or prostate cancer may block the urethra and prevent the bladder from emptying.
- Tumors in the abdomen that surround and obstruct the ureters.
- Kidney stones.
Chronic renal failure develops over months and years. The most common causes of chronic renal failure are related to:
- Poorly controlled diabetes.
- Poorly controlled high blood pressure.
- Chronic glomerulonephritis.
Less common causes:
- Polycystic kidney disease.
- Reflux nephropathy.
- Kidney stones.
- Prostate disease.
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