Causes and Risk Factors of Acute Renal Failure

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Acute renal failure is caused by a variety of medical conditions that can damage the kidneys. The kidneys may rapidly fail if they are directly damaged by drugs or other toxins, if they are deprived of blood and oxygen, or if they are affected by dysfunction in any region of the urinary system.

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Common Causes

There are a number of common causes of acute renal failure. Often, the kidneys can withstand illnesses and are often able to continue to function when you become sick. 

The conditions that cause acute renal failure generally occur suddenly, causing severe damage to the kidneys within a few hours of days. 

Toxins

Most drugs, chemicals, and medications must pass through the kidneys as they are processed in the body. Chemical components can induce toxic damage to the kidneys, causing them to fail.

When this happens, the cause is obvious if a medication that is associated with acute renal failure was administered in a hospital setting.

If the cause of kidney failure is a medication that you took at home and forgot about, then it may be more difficult to identify the cause of your acute renal failure.

Medical treatments that are associated with kidney failure include: 

  • Contrast is given for imaging studies, such as CT scans and MRI scans
  • Antibiotics, such as Aminoglycosides (streptomycin, gentamycin, and amikacin) and vancomycin
  • ACE Inhibitors, such as Lotensin (benazepril) and Prinivil (lisinopril)
  • Nonsteroidal anti-inflammatories drugs (NSAIDs), such as Motrin, Advil (ibuprofen), Naprosyn, and Aleve (naproxen) 
  • Zyloprim and Aloprim (allopurinol)
  • Lasix (furosemide)
  • Proton pump inhibitors, such as Prilosec (omeprazole), Nexium (esomeprazole magnesium), or Prevacid (lansoprazole)

Shock

Shock is a physiological situation in which the body is overwhelmed by alterations in function.

Conditions such as rapid blood loss, extreme dehydration, overwhelming infection, or organ failure can all lead to shock.

These conditions cause the blood pressure or blood supply to fall below the threshold required for sustainable kidney function and can cause sudden damage to the kidneys. 

Sepsis

Sepsis is an infection that involves the blood and may spread to organs as well. Sepsis causes acute renal failure as a result of either shock, the spread of infection to the kidneys, or both. 

Post Surgery

Acute renal failure can develop in the first few days after surgery. Several known risk factors make it more likely for you to develop acute renal failure after surgery.

In general, the less optimal your health is immediately before surgery and in the days following the procedure, the higher the likelihood that acute renal failure can occur.

Risk factors that increase the chances of acute renal failure after surgery include:

  • Age: Advancing age is more often associated with acute renal failure after surgery than young age is, particularly for people who already have kidney disease. 
  • Diminished kidney function prior to surgery: A person who already has diminished kidney function is more likely to experience acute renal failure after surgery than someone who does not have kidney problems. 
  • Other medical conditions: If you have high blood pressure, heart disease, or diabetes, you are at a higher risk of acute renal failure after surgery.
  • Type of surgery: Having a major surgical procedure on your heart or blood vessels causes changes in blood flow and may increase your risk of acute renal failure after surgery.
  • Medical complications: Traumatic injuries, significant blood loss, low blood pressure, decreased oxygen levels, or septic shock before, during, or after surgery can also increase the chances of developing acute renal failure. This is due to the inability of the kidney to function as it should when exposed to these conditions.  
  • Urinary tract infection: Developing a severe urinary tract infection after surgery can result in acute renal failure, particularly if the infection is not treated or if it does not improve with treatment. 

Acute renal failure that develops after surgery can be detected by blood tests. For example, if a man has a creatinine of .8 mg/dl before surgery and a creatinine level of 1.6 after surgery, this would point to acute kidney failure.

Urine output is another measure of acute renal failure. A urine output of fewer than 0.5 milliliters of urine per kilogram of body weight per hour that lasts for six hours or more indicates acute kidney failure.

Most people who experience acute renal failure after surgery will improve within a few weeks.

If you experience acute renal failure after surgery and require dialysis, your kidney function should improve enough that dialysis will not be necessary for the long-term. Less often, the kidney damage is permanent and long-term dialysis is necessary. If this happens, dialysis is needed until a kidney transplant can provide a functional kidney. 

Allergic Reaction

A major allergic reaction is generally rapid in progression and can affect heart function and blood flow to the extent that the kidneys may be deprived of adequate blood and oxygen. Acute renal failure is the consequence. 

Glomerulonephritis

Glomerulonephritis is inflammation of the kidneys and generally occurs slowly, causing progressive kidney damage. However, it can reach a point at which it suddenly becomes apparent, causing severe and rapidly progressive symptoms similar to those of acute renal failure.

Causes of Glomerulonephritis,

Sometimes, the cause of glomerulonephritis is not known. Known causes include:

  • Infections
  • Autoimmune disease
  • Vascular inflammation

Inflammatory Disease

Inflammatory conditions, such as lupus and Berger's disease, cause inflammation of varying degrees and can affect any organ of the body. The inflammation affects the kidneys over time, causing progressive, rather than acute renal failure. As with glomerulonephritis, the gradual kidney failure can produce sudden symptoms and may suddenly become noticeable over a short period of time. 

Genetics

Recent research has attempted to identify whether there is a genetic or familial tendency to develop acute renal failure. Scientists may have found some genetic links, but the research is still fairly new and the association appears to be weak. Overall, it is still difficult to draw definitive conclusions about the genetics of acute renal failure at this time. 

Cardiovascular

The blood supply to the kidneys can be affected by conditions involving the heart or the blood vessels. Blood clots can also affect the kidneys. When these events occur rapidly, they cause sudden kidney damage, resulting in acute renal failure. 

Heart Attack

A heart attack is a medical crisis that can cause a rapid decrease in the blood supply to any organ of the body, including the kidneys. The lack of blood flow and oxygen supply may cause acute renal failure, as the kidneys cannot function or sustain themselves without adequate blood and oxygen. 

Blood Clots

Blood clots can form in the blood vessels of the kidneys or may travel from elsewhere in the body to the kidneys. If a large enough area of the kidney suffers from lack of blood flow due to blockage from a blood clot, then acute renal failure can occur. 

Vascular Disease

When blood vessels are affected by diseases such as atherosclerosis (hardening of the arteries) or vasculitis (inflammation of the blood vessels), it typically affects blood vessels throughout the body. This includes those that supply the kidneys.

Vascular disease generally causes a slow progression of kidney failure, rather than acute renal failure. But, after a period of a slow progression without symptoms or obvious effects, vascular disease may suddenly cause symptoms that are similar to the symptoms of acute renal failure. 

Lifestyle 

In general, lifestyle issues are not the leading cause of acute renal failure. But, there are some factors that are at least partially under your control that can increase your chances of developing the condition.

Illegal Drug Use

The use of illegal drugs can cause sudden, rapid toxicity to the kidneys. In addition, injected drugs increase the risk of aggressive infections that can progress to cause sepsis. 

Heavy Alcohol Use

Heavy alcohol use, which is considered more than 10 to 14 drinks per week, is a cause of slowly progressive kidney damage. Heavy alcohol use damages the liver. In fact, alcohol targets the liver more than it targets the kidneys. The liver and kidneys both metabolize (break down and detoxify) food, medications, and substances that circulate throughout the body.

In addition to the direct damage of alcohol on the kidneys, when the liver is damaged and cannot metabolize materials properly, the kidneys are more likely to bear the brunt of the toxins in the body and can fail as well.

Kidney failure due to alcohol is a slow process. Like other gradual causes, the effects may suddenly become noticeable and appear as acute renal failure. 

Analgesic Overuse 

Because several over-the-counter pain medications may cause acute renal failure, excessive use of these medications can increase your risk of developing the condition, too. If you take large amounts of pain medication, discuss your pain and health conditions with your doctor.

Using pain medication on a daily basis results in rebound pain when the medications wear off, creating a cycle that potentially exposes you to unnecessary and possibly damaging medication doses.

If you are relying on high doses of pain medication on a regular basis, the cause of your pain could be a serious health problem that should be evaluated.

Frequently Asked Questions

What are the causes of acute prerenal failure?

Prerenal causes of acute kidney failure are those that directly or indirectly decrease blood flow to the kidneys and, in turn, the rate the kidneys filter waste. Common causes include:

  • Severe dehydration
  • Severe low blood pressure (hypotension)
  • Heart failure
  • Advanced liver disease
  • Narrowing of the renal artery or veins (renal stenosis)

What are the causes of acute intrinsic renal failure?

Intrinsic causes of acute renal failure are those that occur within the kidney itself, affecting either the filters of the kidneys (glomeruli), kidney tubules, or the tissues between these structures (interstitium). The three most common causes of this are:

  • Glomerulonephritis
  • Acute tubular necrosis (ATN)
  • Acute interstitial nephritis (AIN)

What are the causes of acute postrenal failure?

Postrenal cause of acute renal failure are those occur downstream from the kidneys and are most often the result of a urinary tract obstruction. Common causes include:

How does heart failure cause acute renal failure?

Blood flow to the kidneys can be affected by circulatory problems in any part of the body. When you have heart failure, your heart muscle is unable to pump enough blood to supply tissues and organs. This can lead to cardiorenal syndrome in which the failure of the heart can directly affect the kidneys (and vice versa).

How does liver disease cause acute renal failure?

Blood flow to the kidneys can be indirectly affected by liver cirrhosis and liver failure. When these conditions occur, blood flow to the intestines is impeded which, in turn, decreases circulation to the kidneys. This can lead to type 1 hepatorenal syndrome, a life-threatening condition that ultimately requires a liver transplant.

How does sepsis cause acute renal failure?

Sepsis occurs when the immune system’s response to an infection causes damage to tissues. This can lead to multi-organ failure, including acute intrinsic kidney failure. Around 19% of people with moderate sepsis develop acute renal failure, increasing to 23% when sepsis is severe and 51% when there is septic shock.

How do drugs cause acute renal failure?

Every drug you take passes through the kidneys to some degree. Some can cause damage to the glomeruli, tubules, or interstitium of a kidney, either over a period of time or when taken at high doses (especially in people with underlying kidney disease). Common culprits include:

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