Clinical Diagnosis of Acute Renal Failure

  • Vittorio E. Andreucci
  • Stefano Federico
  • Bruno Memoli
  • Mario Usberti


For practical purposes, we may define acute renal failure (ARF) as any abrupt elevation of serum creatinine (SCr) above 177 µmol/l (2 mg/ dl) or, in patients with stabilized chronic renal failure (CRF) a sudden increase in SCr by 50% of the baseline value. This renal shutdown may occur with complete anuria or oliguria or with preserved urine output (nonoliguric ARF).


Acute Renal Failure Blood Urea Nitrogen Serum Potassium Concentration HYPERVOLEMIC Hyponatremia Renal Cortical Necrosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Bastl CP, Rudnick MR, Narins RG. Diagnostic approaches to acute renal failure. In Acute Renal Failure, Brenner BM, Stein JH (eds). New York; Churchill Livingstone, 1980, pp. 17–51.Google Scholar
  2. 2.
    Eliahou HE, Bata A. The diagnosis of acute renal failure. Nephron 2: 287–295, 1965.CrossRefGoogle Scholar
  3. 3.
    Oken DE. Clinical aspects of acute renal failure (vasomotor nephropathy). In Pediatric Kidney Disease, Edelman CM (ed). Boston: Little, Brown and Company, 1978, pp. 1108–1119.Google Scholar
  4. 4.
    Miller TR, Anderson RJ, Linas SL, Henrich WL, Berns AS, Gabow PA, Schrier RW. Urinary diagnostic indices in acute renal failure. A prospective study. Ann Intern Med 89: 47–50, 1978.PubMedGoogle Scholar
  5. 5.
    Hanley MJ, Davidson K. Prior mannitol and furosemide infusion in a model of ischemic acute renal failure. Am J Physiol 10: F-556–564, 1981.Google Scholar
  6. 6.
    Handa SP, Marrin PAF. Diagnostic indices in acute renal failure. Can Med Ass J 96: 78–82, 1967.PubMedGoogle Scholar
  7. 7.
    Espinel CH. The FENa test. JAMA 236: 579–581, 1976.PubMedCrossRefGoogle Scholar
  8. 8.
    Espinel CH, Gregory AW. Differential diagnosis of acute renal failure. Clin Nephrol 13: 73–77, 1980.PubMedGoogle Scholar
  9. 9.
    Oken DE. On the differential diagnosis of acute renal failure. Am J Med 71: 916–920, 1981.PubMedCrossRefGoogle Scholar
  10. 10.
    Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 16: 31–41, 1976.PubMedCrossRefGoogle Scholar
  11. 11.
    Jacobsen FK, Christensen CK, Mogensen CE, Andreasen F, Heilskov NSC. Pronounced increase in serum creatinine concentration after eating cooked meat. Brit Med J 1: 1049–1050, 1979.PubMedCrossRefGoogle Scholar
  12. 12.
    Berglund F, Killander J, Pompeius R. Effect of trimethoprim-sulfamethoxazole on the renal excretion of creatinine in man. J Urol 114: 802, 1975.PubMedGoogle Scholar
  13. 13.
    Dubb JW, Stote RM, Familiar RG, Lee K. Alexander F. Effect of cimetidine on renal function in normal man. Clin Pharmacol Ther 24: 76, 1978.PubMedGoogle Scholar
  14. 14.
    Saah AJ, Hoch TR, Drusano GL. Cefoxitin falsely elevates creatinine levels. JAMA 247: 205–206, 1982.PubMedCrossRefGoogle Scholar
  15. 15.
    Pasternak A, Kuhlback B. Diurnal variation of serum and urine creatine and creatinine. Scand J Clin Lab Invest 27: 1–7, 1971.CrossRefGoogle Scholar
  16. 16.
    Bull GM, Joekes AM, Lowe KG. Renal function studies in acute tubular necrosis. Clin Sci 9: 379–404, 1950.Google Scholar
  17. 17.
    Hall PW, Vasiljevic. Beta2-microglobulin excretion as an index of renal tubular disorders with special reference to endemic Balkan nephropathy. J Lab Clin Med 81: 897–904, 1973.PubMedGoogle Scholar
  18. 18.
    Fredriksson A. Renal handling of beta2-microglobulin in experimental renal disease. Scand J Clin Lab Invest 35: 591–600, 1975.PubMedGoogle Scholar
  19. 19.
    Wibell L, Evrin PE, Berggard I. Serum B2-microglobulin in renal disease. Nephron 10: 320–331, 1973.PubMedCrossRefGoogle Scholar
  20. 20.
    Kult J, Lammilein Ch, Rocken A, Heidland A. Beta-2-Mikroglobulin im Serum-ein Parameter des Glomerulofiltrates. Dtsch Med Wochenschr 99: 1686–1688, 1974.PubMedCrossRefGoogle Scholar
  21. 21.
    Viberti GC, Keen H, Mackintosh D. Beta2-microglobulinemia: A sensitive index of diminishing renal function in diabetics. Brit Med J 282: 95–98, 1981.CrossRefGoogle Scholar
  22. 22.
    Kawai T, Kin K. Diurnal variation of serum B2-microglobulin in normal subjects. N Engl J Med 293: 879–880, 1975.PubMedGoogle Scholar
  23. 23.
    Andreucci VE. Chronic renal failure. In The Treatment of Renal Failure, Castro JE (ed). Lancaster: MTP Press Limited, 1982, pp. 33–167.Google Scholar
  24. 24.
    Rose BD. Acute renal failure. In Pathophysiology of Renal Disease, Rose BD (ed). New York: McGraw-Hill, 1981, pp. 55–95.Google Scholar
  25. 25.
    Perlmutter M, Grossman SL, Rothenberg S. Urine-serum urea nitrogen ratio. JAMA 170: 1533–1537, 1959.Google Scholar
  26. 26.
    Conte G, Dal Canton A, Terribile M, Capuano A, Cianciaruso B, Genualdo R, Russo D, Andreucci VE. Iperazotemia persistente in soggetti con normo-funzione renale, Nefrologia, Dialisi, Trapianto (Wichtig Editor Milan, Italy) 1983, pp. 367-368.Google Scholar
  27. 27.
    Dal Canton A, Fuiano G, Conte G, Terribile M, Sabbatini M, Cianciaruso B, Andreucci VE. Why diuretic treatment increases azoteuria. Proc EDTA 19: 744–748, 1982.Google Scholar
  28. 28.
    Rose BD. Tubulointerstitial diseases. In Pathophysiology of Renal Disease, Rose BD (ed). New York: McGraw-Hill, 1981, pp. 295–345.Google Scholar
  29. 29.
    Yu TF, Berger L. The Kidney in Gout and Hyper-uricemia. Mount Kisco, NY: Futura Publishing, 1982.Google Scholar
  30. 30.
    Kelton J, Kelley WN, Holmes EW. A rapid method for the diagnosis of acute uric acid nephropathy. Arch Intern Med 138: 612–615, 1978.PubMedCrossRefGoogle Scholar
  31. 31.
    Narins RG, Jones ER, Stom MC, Rudnick MR, Bastl CP: Diagnostic strategies in disorders of fluid electrolyte and acid-base homeostasis. Am J Med 72: 496–520, 1982.PubMedCrossRefGoogle Scholar
  32. 32.
    Morgan DB, Thomas TH. Water balance and hyponatremia. Clin Sci 56: 517–522, 1979.PubMedGoogle Scholar
  33. 33.
    Arieff AI. Principles of parenteral therapy. In Clinical Disorders of Fluid and Electrolyte Metabolism, Maxwell MH, Kleeman CR (eds). New York: McGraw-Hill, 1972, pp. 567–589.Google Scholar
  34. 34.
    Goldfarb S, Cox M, Singer I, Goldberg M. Acute hyperkalemia induced by hyperglicemia: Hormonal mechanisms. Ann Intern Med 84: 426–432, 1976.PubMedGoogle Scholar
  35. 35.
    Seldin DW, Rector FC Jr. The generation and maintenance of metabolic alkalosis. Kidney Int 1: 305–321, 1972.CrossRefGoogle Scholar
  36. 36.
    McCarron DA, Elliott WC, Rose JS, Bennett WM. Severe mixed metabolic acidosis secondary to rhab-domyolysis. Am J Med 67: 905–908, 1979.PubMedCrossRefGoogle Scholar
  37. 37.
    Meroney WH, Herndon RF. The management of acute renal insufficiency. JAMA 155: 877–883, 1954.Google Scholar
  38. 38.
    Pietrek J, Kokot F, Kuska J. Serum 25-hydroxyvitamin D and parathyroid hormone, in patients with acute renal failure. Kidney Int 13: 178–185, 1978.PubMedCrossRefGoogle Scholar
  39. 39.
    Massry SG, Arieff AI, Coburn JW, Palmieri G, Kleeman CR. Divalent ion metabolism in patients with acute renal failure: Studies on the mechanism of hypocalcemia. Kidney Int 5: 437–445, 1974.PubMedCrossRefGoogle Scholar
  40. 40.
    Meroney WH, Arney GK, Segar WE, Balch HH. The acute calcification of traumatized muscle, with particular reference to acute posttraumatic renal insufficiency. J Clin Invest 36: 825–832, 1956.CrossRefGoogle Scholar
  41. 41.
    Akmal M, Goldstein DA, Telfer N, Wilkinson E, Massry SG. Resolution of muscle calcification in rhabdomyolysis and acute renal failure. Ann Intern Med 89: 928–930, 1978.PubMedGoogle Scholar
  42. 42.
    Vanhille P, Raviart B, Tacquet A, Jovet JP, Huart JJ, Bauters F, Goudemand M. Insuffisance rénale aigüe par hyperphosphatémie majeure an cours de leucémies aiguës lymphoblastiques. Nouv Presse Med 8: 3977–3979, 1979.Google Scholar
  43. 43.
    Kaplan BS, Hebert D, Morrell RE. Acute renal failure induced by hyperphosphatemia in acute lymphoblastic leukemia. Can Med Ass J 124: 429–431, 1981.PubMedGoogle Scholar
  44. 44.
    Feinstein EI, Akmal M, Goldstein DA, Telfer N, Massry SG. Hypercalcemia and acute widespread calcification during the oliguric phase of acute renal failure due to rhabdomyolysis. Mineral Electrolyte Metab 2: 193–200, 1979.Google Scholar
  45. 45.
    Zabetakis PM, Singh R, Michelis MF, Murdaugh HV. Acute renal failure. Bone immobilization as cause of hypercalcemia. NY State J Med 79: 1887–1891, 1979.Google Scholar
  46. 46.
    Pasternack A, Wahlberg P. Bone marrow in acute renal failure. Acta Med Scand 181: 505–511, 1967.PubMedCrossRefGoogle Scholar
  47. 47.
    Diamond JR, Yoburn DC. Nonoliguric acute renal failure. Arch Intern Med 142: 1882–1898, 1982.PubMedCrossRefGoogle Scholar
  48. 48.
    Vertel RM, Knochel JP. Nonoliguric acute renal failure. JAMA 200: 598–602, 1967.PubMedCrossRefGoogle Scholar
  49. 49.
    Danovitch G, Carvounis C, Wlinstein E, Levenson S. Nonoliguric acute renal failure. Isr J Med Sci 15: 5–8, 1979.PubMedGoogle Scholar
  50. 50.
    Counahan R, Cameron JS, Ogg CS, Spurgeon P, Williams DG, Winder E, Chantier C. Presentation, management, complications, and outcome of acute renal failure in childhood: Five years’ experience. Brit Med J 1: 599–602, 1977.PubMedCrossRefGoogle Scholar
  51. 51.
    Hilberman M, Myers BD, Carrie BJ, Derby G, Jamison RL, Stinson EB. Acute renal failure following cardiac surgery. J Thorac Cardiovasc Surg 77: 880–888, 1979.PubMedGoogle Scholar
  52. 52.
    Schrier RW, Gardenswartz MH, Burke TJ. Acute renal failure: Pathogenesis, diagnosis and treatment. Adv Nephrol 10: 213–240, 1981.Google Scholar
  53. 53.
    Miller PD, Krebs RA, Neal BJ, McIntyre DO. Polyuric prerenal failure. Arch Intern Med 140: 907–909, 1980.PubMedCrossRefGoogle Scholar
  54. 54.
    Hong CD, Kapoor BS, First MR, Pollak VE, Alexander JW. Fractional excretion of sodium after renal transplantation. Kidney Int 16: 167–178, 1979.PubMedCrossRefGoogle Scholar

Copyright information

© Martinus Nijhoff Publishing, Boston 1984

Authors and Affiliations

  • Vittorio E. Andreucci
  • Stefano Federico
  • Bruno Memoli
  • Mario Usberti

There are no affiliations available

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