Prerenal ARF Structurally, the kidneys are normal and respond appropriately to the various prerenal causes, in particular, sudden marked decrease in vascular volume and or cardiac output, which leads to hormonal changes. Renal ultrasound is normal. Oliguria or anuria interspersed with polyuria are indicators of urinary tract obstruction. Further decrease in GFR Management comprises removal of obstruction surgically or by percutaneous nephrostomy. The 2 basic pathogenic mechanisms for ATN are ischemia and nephrotoxicity.
Ischemia is caused by the mechanisms listed.
If the hypoperfusion that causes prerenal failure continues,a second mechanism sets in that maintains oliguria. In patients with ATN associated with hemoglobinuria and myoglobin-uria, poorly understood factors in addition to urine excretion of Hb and myoglobin contribute to the nephrotoxicity. The clinical identification of the causes listed. These measures are particularly important in cardiac or cardiovascular surgery, in patients at high risk for hemoglobinuria or myoglobinuria and when radiocontrast dyes are used. Allopurinol 600 mg prior to and 300 mg qd afgter chemotherapy in various myeloproliferative disorders.