Major Causes of Acute Kidney Injury

Prerenal

ECF volume depletion

Excessive diuresis

Gastrointestinal losses

Hemorrhage

Loss of intravascular fluid into the extravascular space (due to ascites, peritonitis, pancreatitis, or burns)

Loss of fluid from skin and mucous membranes

Renal salt- and water-wasting states

Low cardiac output

Cardiac tamponade

Cardiomyopathy with reduced left ventricular systolic function

Myocardial infarction with cardiogenic shock or exacerbation of underlying heart failure

Pulmonary embolism

Pulmonary hypertension

Low systemic vascular resistance

Anaphylactic shock

Antihypertensive medications

Liver failure

Septic shock

Vasoconstriction of afferent and glomerular arterioles

Hypercalcemia

NSAIDs

Decreased efferent arteriolar tone (leading to decreased GFR from reduced glomerular transcapillary pressure, especially in patients with bilateral renal artery stenosis)

ACE inhibitors

ARBs

Renal

Acute tubular injury

Ischemia (prolonged or severe prerenal state):

• Hemorrhage

• NSAIDs

• Surgery

• Vascular obstruction (arterial or venous)

Toxins:

• Aminoglycosides

• Ethylene glycol

• Heavy metals

• Hemoglobin (as in hemoglobinuria)

• Myoglobin (as in myoglobinuria)

• Radiopaque contrast agents

• Streptozotocin

Acute glomerulonephritis

ANCA-associated:

• Crescentic glomerulonephritis

• Granulomatosis with polyangiitis

• Microscopic polyangiitis

Anti-GBM glomerulonephritis (Goodpasture syndrome)

Immune-complex:

• Cryoglobulinemic glomerulonephritis

• Lupus glomerulonephritis

• Postinfectious glomerulonephritis

Acute tubulointerstitial nephritis

Papillary necrosis

Pyelonephritis

Acute vascular nephropathy

Atheroembolism

Malignant hypertension

Systemic sclerosis

Thrombotic microangiopathies

Vasculitis

Infiltrative diseases

Leukemia

Lymphoma

Sarcoidosis

Postrenal

Tubular precipitation

Calcium oxalate (due to ingestion of ethylene glycol or excessive vitamin C)

Myeloma protein

Myoglobin

Sulfonamides

Uric acid (tumor lysis)

Ureteral obstruction

Intrinsic:

• Calculi

• Cancer

• Clots

• Congenital defects

• Edema

• Fungus ball

• Sloughed renal tissue

Extrinsic:

• Cancer

• Retroperitoneal fibrosis

• Ureteral trauma during surgery or high-impact injury

Bladder obstruction

Mechanical:

• Benign prostatic hyperplasia

• Bladder cancer

• Obstructed indwelling urinary catheter

• Paraphimosis

• Phimosis

• Prostate cancer

• Urethral strictures

• Urethral valves

Neurogenic:

• Anticholinergic medications

• Upper or lower motor neuron lesion