oliguric acute renal failure

乏尿性急性腎不全

WordNet

1. lack of success; "he felt that his entire life had been a failure"; "that year there was a crop failure"
2. loss of ability to function normally; "kidney failure"
3. an act that fails; "his failure to pass the test"
4. an unexpected omission; "he resented my failure to return his call"; "the mechanics failure to check the brakes"
5. a person with a record of failing; someone who loses consistently (同)loser, nonstarter, unsuccessful person
6. an event that does not accomplish its intended purpose; "the surprise party was a complete failure"
7. of critical importance and consequence; "an acute (or critical) lack of research funds"
8. having or demonstrating ability to recognize or draw fine distinctions; "an acute observer of politics and politicians"; "incisive comments"; "icy knifelike reasoning"; "as sharp and incisive as the stroke of a fang"; "penetrating insight"; "frequent penetrative observations" (同)discriminating, incisive, keen, knifelike, penetrating, penetrative, piercing, sharp
9. extremely sharp or intense; "acute pain"; "felt acute annoyance"; "intense itching and burning" (同)intense
10. having or experiencing a rapid onset and short but severe course; "acute appendicitis"; "the acute phase of the illness"; "acute patients"
11. of an angle; less than 90 degrees

PrepTutorEJDIC

1. 〈U〉(…における)『失敗』,不成功《+『in』+『名』(do『ing』)》 / 〈C〉失敗者,落後者;失敗した企て,不できなもの / 〈U〉〈C〉怠慢,不履行 / 〈U〉〈C〉(…の)不足,欠乏《+『of』+『名』》 / 〈U〉〈C〉(…の)破産《+『of』+『名』》 / 〈U〉(…の)『衰弱』,減退《+『in』(『of』+『名』》
2. (先の)『鋭い』,とがった / (痛み・感情などが)『激しい』,強い / (知力・感覚などが)『鋭い』,鋭敏な / (事態が)重大な / (病気が)急性の / (音が)高い,鋭い / 鋭角の
3. 腎臓の

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/05/26 06:35:35」(JST)

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Renal failure
A hemodialysis machine, used to replace the function of the kidneys in renal failure
Classification and external resources
Specialty	Nephrology
ICD-10	N17-N19
ICD-9-CM	584-585
DiseasesDB	26060
MeSH	C12.777.419.780.500

Kidney failure, also known as renal failure or renal insufficiency, is a medical condition in which the kidneys fail to adequately filter waste products from the blood. The two main forms are acute kidney injury, which is often reversible with adequate treatment, and chronic kidney disease, which is often not reversible. In both cases, there is usually an underlying cause.

Kidney failure is mainly determined by a decrease in glomerular filtration rate, which is the rate at which blood is filtered in the glomeruli of the kidney. The condition is detected by a decrease in or absence of urine production or determination of waste products (creatinine or urea) in the blood. Depending on the cause, hematuria (blood loss in the urine) and proteinuria (protein loss in the urine) may be noted.

In kidney failure, there may be problems with increased fluid in the body (leading to swelling), increased acid levels, raised levels of potassium, decreased levels of calcium, increased levels of phosphate, and in later stages anemia. Bone health may also be affected. Long-term kidney problems are associated with an increased risk of cardiovascular disease.

Classification

Kidney failure can be divided into two categories: acute kidney injury or chronic kidney disease. The type of renal failure is differentiated by the trend in the serum creatinine; other factors that may help differentiate acute kidney injury from chronic kidney disease include anemia and the kidney size on sonography as chronic kidney disease generally leads to anemia and small kidney size.

Acute kidney injury

Main article: Acute kidney injury

Acute kidney injury (AKI), previously called acute renal failure (ARF), is a rapidly progressive loss of renal function, generally characterized by oliguria (decreased urine production, quantified as less than 400 mL per day in adults, less than 0.5 mL/kg/h in children or less than 1 mL/kg/h in infants); and fluid and electrolyte imbalance. AKI can result from a variety of causes, generally classified as prerenal, intrinsic, and postrenal. The underlying cause must be identified and treated to arrest the progress, and dialysis may be necessary to bridge the time gap required for treating these fundamental causes.

Chronic kidney disease

Main article: Chronic kidney disease

Chronic kidney disease (CKD) can also develop slowly and, initially, show few symptoms. CKD can be the long term consequence of irreversible acute disease or part of a disease progression.

Acute-on-chronic kidney failure

Acute kidney injuries can be present on top of chronic kidney disease, a condition called acute-on-chronic kidney failure (AoCRF). The acute part of AoCRF may be reversible, and the goal of treatment, as with AKI, is to return the patient to baseline kidney function, typically measured by serum creatinine. Like AKI, AoCRF can be difficult to distinguish from chronic kidney disease if the patient has not been monitored by a physician and no baseline (i.e., past) blood work is available for comparison.

Signs and symptoms

Symptoms can vary from person to person. Someone in early stage kidney disease may not feel sick or notice symptoms as they occur. When kidneys fail to filter properly, waste accumulates in the blood and the body, a condition called azotemia. Very low levels of azotaemia may produce few, if any, symptoms. If the disease progresses, symptoms become noticeable (if the failure is of sufficient degree to cause symptoms). Kidney failure accompanied by noticeable symptoms is termed uraemia.

Symptoms of kidney failure include the following:

• High levels of urea in the blood, which can result in:
  • Vomiting and/or diarrhea, which may lead to dehydration
  • Nausea
  • Weight loss
  • Nocturnal urination
  • More frequent urination, or in greater amounts than usual, with pale urine
  • Less frequent urination, or in smaller amounts than usual, with dark coloured urine
  • Blood in the urine
  • Pressure, or difficulty urinating
  • Unusual amounts of urination, usually in large quantities
• A buildup of phosphates in the blood that diseased kidneys cannot filter out may cause:
  • Itching
  • Bone damage
  • Nonunion in broken bones
  • Muscle cramps (caused by low levels of calcium which can be associated with hyperphosphatemia)
• A buildup of potassium in the blood that diseased kidneys cannot filter out (called hyperkalemia) may cause:
  • Abnormal heart rhythms
  • Muscle paralysis
• Failure of kidneys to remove excess fluid may cause:
  • Swelling of the legs, ankles, feet, face and/or hands
  • Shortness of breath due to extra fluid on the lungs (may also be caused by anemia)
• Polycystic kidney disease, which causes large, fluid-filled cysts on the kidneys and sometimes the liver, can cause:
  • Pain in the back or side
• Healthy kidneys produce the hormone erythropoietin that stimulates the bone marrow to make oxygen-carrying red blood cells. As the kidneys fail, they produce less erythropoietin, resulting in decreased production of red blood cells to replace the natural breakdown of old red blood cells. As a result, the blood carries less hemoglobin, a condition known as anemia. This can result in:
  • Feeling tired and/or weak
  • Memory problems
  • Difficulty concentrating
  • Dizziness
  • Low blood pressure
• Normally, proteins are too large to pass through the kidneys, however, they are able to pass through when the glomeruli are damaged. This does not cause symptoms until extensive kidney damage has occurred, after which symptoms include:
  • Foamy or bubbly urine
  • Swelling in the hands, feet, abdomen, or face
• Other symptoms include:
  • Appetite loss, a bad taste in the mouth
  • Difficulty sleeping
  • Darkening of the skin
  • Excess protein in the blood
  • With high dose penicillin, people with kidney failure may experience seizures

Causes

Acute kidney injury

Acute kidney injury (previously known as acute renal failure) - or AKI - usually occurs when the blood supply to the kidneys is suddenly interrupted or when the kidneys become overloaded with toxins. Causes of acute kidney injury include accidents, injuries, or complications from surgeries in which the kidneys are deprived of normal blood flow for extended periods of time. Heart-bypass surgery is an example of one such procedure.

Drug overdoses, accidental or from chemical overloads of drugs such as antibiotics or chemotherapy, may also cause the onset of acute kidney injury. Unlike chronic kidney disease, however, the kidneys can often recover from acute kidney injury, allowing the patient to resume a normal life. People suffering from acute kidney injury require supportive treatment until their kidneys recover function, and they often remain at increased risk of developing future kidney failure.

Among the accidental causes of renal failure is the crush syndrome, when large amounts of toxins are suddenly released in the blood circulation after a long compressed limb is suddenly relieved from the pressure obstructing the blood flow through its tissues, causing ischemia. The resulting overload can lead to the clogging and the destruction of the kidneys. It is a reperfusion injury that appears after the release of the crushing pressure. The mechanism is believed to be the release into the bloodstream of muscle breakdown products – notably myoglobin, potassium, and phosphorus – that are the products of rhabdomyolysis (the breakdown of skeletal muscle damaged by ischemic conditions). The specific action on the kidneys is not fully understood, but may be due in part to nephrotoxic metabolites of myoglobin.

Chronic kidney disease

Chronic kidney disease (CKD) has numerous causes. The most common causes of CKD are diabetes mellitus and long-term, uncontrolled hypertension. Polycystic kidney disease is another well-known cause of CKD. The majority of people afflicted with polycystic kidney disease have a family history of the disease. Other genetic illnesses affect kidney function, as well.

Overuse of common drugs such as ibuprofen, and acetaminophen (paracetamol) can also cause chronic kidney damage.

Some infectious disease agents, such as hantavirus, can attack the kidneys, causing kidney failure.

Genetic predisposition

The APOL1 gene has been proposed as a major genetic risk locus for a spectrum of nondiabetic renal failure in individuals of African origin, these include HIV-associated nephropathy (HIVAN), primary nonmonogenic forms of focal segmental glomerulosclerosis, and hypertension affiliated chronic kidney disease not attributed to other etiologies. Two western African variants in APOL1 have been shown to be associated with end stage kidney disease in African Americans and Hispanic Americans.

Diagnostic approach

Measurement for CKD

Stages of kidney failure

Chronic kidney failure is measured in five stages, which are calculated using a patient’s GFR, or glomerular filtration rate. Stage 1 CKD is mildly diminished renal function, with few overt symptoms. Stages 2 and 3 need increasing levels of supportive care from their medical providers to slow and treat their renal dysfunction. Patients in stages 4 and 5 usually require preparation of the patient towards active treatment in order to survive. Stage 5 CKD is considered a severe illness and requires some form of renal replacement therapy (dialysis) or kidney transplant whenever feasible.

Glomerular filtration rate

A normal GFR varies according to many factors, including sex, age, body size and ethnic background. Renal professionals consider the glomerular filtration rate (GFR) to be the best overall index of kidney function. The National Kidney Foundation offers an easy to use on-line GFR calculator for anyone who is interested in knowing their glomerular filtration rate. (A serum creatinine level, a simple blood test, is needed to use the calculator.)

Use of the term uremia

Before the advancement of modern medicine, renal failure was often referred to as uremic poisoning. Uremia was the term for the contamination of the blood with urine. It is the presence of an excessive amount of urea in blood. Starting around 1847, this included reduced urine output, which was thought to be caused by the urine mixing with the blood instead of being voided through the urethra. The term uremia is now used for the illness accompanying kidney failure.

References

External links

• Connecting dialysis community around the World (US)
• National Kidney Foundation (US)
• The Kidney Foundation of Canada(CA)

UpToDate Contents

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• 1. 急性腎障害（急性腎不全）のマネージメントの概要 overview of the management of acute kidney injury acute renal failure
• 2. 非乏尿性と乏尿性の急性尿細管壊死の比較 nonoliguric versus oliguric acute tubular necrosis
• 3. 急性腎障害（急性腎不全）または慢性腎臓病患者に対する診断的アプローチ diagnostic approach to the patient with acute kidney injury acute renal failure or chronic kidney disease
• 4. 挫滅関連の急性腎障害（急性腎不全） crush related acute kidney injury acute renal failure
• 5. ヘム色素誘発急性腎障害（急性腎不全）の予防および治療 prevention and treatment of heme pigment induced acute kidney injury acute renal failure

English Journal

• Incremental haemodialysis.

• Wong J1, Vilar E1, Davenport A2, Farrington K1.
• Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.Nephrol Dial Transplant.2015 Oct;30(10):1639-48. doi: 10.1093/ndt/gfv231. Epub 2015 Jun 1.
• Thrice-weekly haemodialysis schedules have become the standard default haemodialysis prescription worldwide. Whereas the measurement of residual renal function is accepted practice for peritoneal dialysis patients and the importance of residual renal function in determining technique success is well
• PMID 26038351

• Acute toluene intoxication--clinical presentation, management and prognosis: a prospective observational study.

• Camara-Lemarroy CR1, Rodríguez-Gutiérrez R2,3, Monreal-Robles R4, González-González JG5.
• BMC emergency medicine.BMC Emerg Med.2015 Aug 18;15:19. doi: 10.1186/s12873-015-0039-0.
• BACKGROUND: Toluene is one of the most widely abused inhaled drugs due to its acute neurologic effects including euphoria and subsequent depression. However, dangerous metabolic abnormalities are associated to acute toluene intoxication. It has been previously reported that rhabdomyolysis and acute
• PMID 26282250

• Elevated serum levels of decoy receptor 3 are associated with disease severity in patients with hemorrhagic fever with renal syndrome.

• Dong Y1, Shi D, Li M, Dai P, Wang X, Xie M.
• Internal and emergency medicine.Intern Emerg Med.2015 Aug;10(5):567-73. doi: 10.1007/s11739-015-1195-7. Epub 2015 Feb 3.
• Hemorrhagic fever with renal syndrome (HFRS) is an acute viral infectious disease characterized by fever, hemorrhage and renal failure. HFRS has become a serious public health problem in China. Unfortunately, the pathogenesis of HFRS has not been completely clarified. The aim of this study is to inv
• PMID 25647584

Japanese Journal

• Posterior reversible encephalopathy syndromeを合併した運動後急性腎不全の1例

• 日本集中治療医学会雑誌 20(3), 405-409, 2013
• NAID 130004846827

• 発症に溶連菌感染の関与が示唆されたＡＮＣＡ陰性顕微鏡的多発血管炎の１例

• 日本小児腎臓病学会雑誌 24(1), 96-102, 2011
• NAID 130001353985

• Hemorrhagic Shock and Obstructive Uropathy Due to a Large Rectus Sheath Hematoma in a Patient on Anticoagulant Therapy

• Internal Medicine 48(24), 2119-2122, 2009
• NAID 130000142089

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★リンクテーブル★

リンク元	「乏尿性急性腎不全」
拡張検索	「non-oliguric acute renal failure」
関連記事	「failure」「acute」「renal」

「乏尿性急性腎不全」

　　[★]

英

oliguric acute renal failure

「non-oliguric acute renal failure」

　　[★] 非乏尿性急性腎不全

「failure」

　　[★]

• n.

• 失敗、不首尾
• 失敗して企て、不出来なもの、失敗者。(教育)落第、落第点
• 怠慢、不履行(to do)。支払い不能、破産、倒産
• 無いこと。不十分、不足
• (力などの)減退。(医)機能不全。故障。(機)破壊、破損

関

abortion、fail、failing、imperfecta、incompetence、insufficiency、unsuccessful、unsuccessfully

　 　 　 　 　 　 　

「acute」

　　[★]

• adj.

• (疾患)急性の、急性型の、急性的な。(形状が)鋭い、鋭角の。(感覚、才知などが)鋭い。明敏な、鋭い眼識のある。

関

acutely、quick、sharp

　 　 　 　 　 　

「renal」

　　[★]

• adj.

• 腎臓の、腎性の、腎の

関

kidney、renally