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.
1. Prerenal causes - comes from the decreased blood supply to the kidney.
Examples of prerenal causes of kidney failure are:
- low blood volume - due to blood loss (hypovolemia);
- loss of body fluid or dehydration process likes sweating, fever etc.
- less of fluids;drinking water in small quantities.
- medication methods likes diuretics ("water pills") may cause excessive water loss; and
- abnormal blood flow to and from the kidney due to obstruction of the renal artery or vein.
2. 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 like ibuprofen and naproxen. Others potentially toxic medications include antibiotics like aminoglycosides [gentamicin (Garamycin), tobramycin], lithium (Eskalith, Lithobid), iodine-containing medications such as those injected for radiology dye studies.
- Rhabdomyolysis: - significant muscle breakdown in the body, and the damaged muscle fibers clog the filtering system of the kidneys. - Coming from trauma, crush injuries, and burns. Some medications used to treat high cholesterol can cause rhabdomyolysis.
- 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.
3.Post renal causes - factors that affect outflow of the urine:
- Obstruction of the bladder or the ureters can cause back pressure because the kidneys continue to produce urine, but the obstruction acts like a dam, and urine backs up into the kidneys. When the pressure increases high enough, the kidneys are damaged and shut down.
- Prostatic hypertrophy or prostate cancer may block the urethra and prevents the bladder from emptying.
- Tumors in the abdomen that surround and obstruct the ureters.
- Kidney stones. Usually, affect only one kidney and do not cause kidney failure. However, if there is only one kidney present, a kidney stone may cause the lone kidney to fail.
4. Chronic renal failure develops over months and years which are related to:
- polycystic kidney disease,
- reflux nephropathy,
- kidney stones, and
- prostate disease.
The CER (cost effectiveness ratios ) by MOH (Ministry of Health, Malaysia)of : -
- centre haemodialysis was RM 21,620/life year saved,
- home haemodialysis was RM 23375/life year saved
- CAPD ( continuous ambulatory peritoneal dialysis) was RM 30469 /life year saved
- IPD (intermittent peritoneal dialysis ) was RM 36016 / life year saved.