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Causes
By Mayo Clinic staff
Acute kidney failure has many possible causes, generally grouped according to the part of kidney function they affect. All your blood flows through your kidneys, which are the key organs in the complex system that removes excess fluid and waste material from the blood.
Your kidneys receive blood through your renal arteries, which branch off the main artery (the abdominal aorta) carrying oxygenated blood away from your heart. On entering the kidneys, blood is diffused through an intricate network of filtering structures. These structures consist of nephrons — approximately 1 million of them — each containing a tuft of capillary blood vessels and tiny lobules that lead to larger collecting tubes. The capillary tufts (glomeruli) filter fluid from your blood, extracting both waste products and substances your body needs continuously — sugar, amino acids, calcium and salts. The filtered fluid then enters the tubules, from which the bloodstream reabsorbs these vital materials. What remains is waste, which is excreted in your urine.
Underlying causes
Three types of conditions can cause acute kidney failure:
- Prerenal conditions, which disrupt blood flow on its way to the kidneys
- Renal conditions, which directly damage the structures of the kidneys
- Postrenal conditions, which interfere with the urinary excretion of waste from the filtering process
Prerenal causes
- Extremely low blood pressure. Severe bleeding, infection in the bloodstream (sepsis), dehydration or shock can all lead to a drastic drop in blood pressure that prevents an adequate amount of blood from reaching your kidneys. Dangerously low blood pressure tends to follow traumatic injury.
- Poor heart function. A heart attack or congestive heart failure can severely limit blood flow to your kidneys.
- Low blood volume. Severe dehydration diminishes the volume of blood in your body and the amount available to your kidneys.
Renal causes
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Reduced blood supply within your kidneys. Your kidneys don't just process blood for the rest of your body — they depend on an adequate blood supply of their own. Reduced blood flow to the kidneys, especially to the renal tubules, can result in acute renal failure.
In atherosclerosis, for example, deposits of cholesterol on the inner walls of arteries (plaques) may break up, releasing solid fragments into the bloodstream. These fragments (emboli) can get into the kidneys' circulation and accumulate in small vessels, severely restricting the blood supply and causing acute kidney failure, also known as atheroembolic kidney disease.
- Hemolytic uremic syndrome. Hemolytic uremic syndrome — associated with certain strains of Escherichia coli (E. coli) bacteria — is a leading cause of acute kidney failure in children. The bacterium causes inflammation of the intestine. It also produces a toxin that causes damage and swelling in the lining of blood vessels, especially the small blood vessels (glomerular capillaries) in the kidneys. As red blood cells travel through the damaged blood vessels, they're often broken apart (hemolysis). This complex condition may result in acute kidney failure.
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Inflammation in the kidneys. Acute kidney failure may result from sudden inflammation of the spaces between the glomeruli and the tubules (acute interstitial nephritis) and inflammation of the glomeruli (acute glomerulonephritis). Acute interstitial nephritis is usually associated with an allergic reaction to a drug. Examples include certain antibiotics — especially streptomycin and gentamicin — and common pain medications, such as aspirin and ibuprofen (Advil, Motrin, others). Antibiotics pose a greater risk of acute kidney failure for people who already have liver or kidney disease or who use diuretics or other drugs that affect the kidneys.
Acute glomerulonephritis may follow a bacterial or viral infection, such as strep throat or hepatitis. Immune system diseases, such as lupus or IgA nephropathy (Berger's disease), also may trigger acute glomerulonephritis.
- Toxic injury. Your kidneys are particularly vulnerable to toxic injury from alcohol, cocaine, heavy metals, solvents and fuels. Sometimes, these toxins can induce acute kidney failure. Some medications, including certain chemotherapy drugs and contrast dyes used in medical tests, have a similar effect in vulnerable people.
Postrenal causes
Conditions that block the passage of urine out of the body (urinary obstructions) can, without treatment, also lead to acute kidney failure.
- Ureter obstruction. Kidney stones in both of the tubes leading from your kidneys to your bladder (ureters) — or in a single ureter if only one kidney is functioning — can prevent the passage of urine, as can tumors pushing in on the ureters.
- Bladder obstruction. In men, prostate enlargement is a common cause of urinary retention due to obstruction at the bladder outlet. Other obstructive bladder causes, in both men and women, include a bladder stone, blood clot, tumor or a nerve disorder that prevents the bladder from contracting properly.
