he occurrence of acute renal failure (ARF) and chronic renal failure (CRF) is more common in the people those who are aged above 64 years, 22 Other comobrbidties like diabetes mellitus, hypertension, obesity and proteinuria are self-governing risk factors for ARF.23, 24 When it is mixed irrational use of medicines, including nephrotoxic medicines are likelihood of an acute- or chronic decline in renal function.
Types and Causes of Acute Renal Failure:
Pre-Renal Failure: Decrease in a blood flow to renal organs is the most commonest cause of AKI, Which is because of failure in auto regulation in maintenance of renal flow.25Consistent decrease in kidney perfusion heightens the inherent kidney failure (acute tubular necrosis), which leads to permanent damage to renal organs.
The main causes of pre-renal injury are:
Hypovolaemia, e.g. In a severe condition of diarrhoea, vomiting, diuretics, osmotic diuresis from poorly glyceamic control, hemorrhage and traumatic or septic shock
Decreased effective blood volume, e.g. heart failure or cirrhosis
Vasoregulation, e.g. Drugs like analgesics and other NSAIDs, Chemotherapeutic agents, Anti tubercular agents, angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), or hypercalcaemia.25
Post-renal injury: It is due to interruption in the normal micturation, resulting in a back pressure to renal organs leads to nephron damage. This obstructive nephropathy and is a relatively exceptional cause of acute kidney injury (5%). Timely diagnosis and treatment can lead to a complete recovery.
The most frequent causes of obstructive nephropathy include:
Urinary tract stones
Prostatic hypertrophy
An intra-abdominal process encasing the ureters, e.g. retroperitoneal fibrosis or prostatic and other pelvic malignancy.25
Intrinsic renal injury: It results due the injury of renal tubules, glomerulus, vascular structures, or obstruction of the renal tubules21 which is the most commonest cause of nephron damage and acute tubular necrosis is the leading among them, Which results in toxicity (hypotension, hypovolaemia, haemolysis, rhabdomyolysis or nephrotoxic medicines, e.g. NSAIDs, lithium or aminoglycosides).25,26 Approximately 90 % of Acute Renal failure is because of history with pre-renal injury and acute tubular necrosis.
Drugs which can cause interstitial nephritis or intrinsic acute renal injury :
