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Medical Author:

John P. Cunha, DO, FACOEP

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Primary renal damage is the most complicated cause of renal failure (accounts for 25% to 40% of cases). Renal causes of acute kidney failure include those affecting the filtering function of the kidney, those affecting the blood supply within the kidney, and those affecting the kidney tissue that handles salt and water processing.

Examples of kidney problems that can cause kidney failure include:

• Blood vessel diseases
• Blood clot in a vessel in the kidneys
• Injury to kidney tissue and cells
• Glomerulonephritis
• Acute interstitial nephritis
• Acute tubular necrosis
• Polycystic kidney disease (PKD)

Glomerulonephritis: The glomeruli, the initial filtration system in the kidney, can be damaged by a variety of diseases, including infections. The resulting inflammation impairs kidney function.

• A common example is a complication of strep throat. Streptococcal bacterial infections may damage the glomeruli.
• Glomerular disorder symptoms may include dark-colored urine (like cola or tea) and back pain.
• Other symptoms include producing less urine than usual, blood in the urine, high blood pressure, and body swelling (retaining water).
• Treatment usually consists of medications and, if kidney function fails significantly, dialysis may be needed to remove life-threatening waste products that cannot be excreted.

Acute interstitial nephritis: This is a sudden decline in renal function caused by inflammation of interstitial kidney tissue that primarily handles salt and water balance rather than the filtering of wastes.

• Medications such as antibiotics, anti-inflammatory medicines (for example, aspirin, ibuprofen), and water pills (diuretics) are the most common causes.
• Other causes include infections and immune-related diseases such as lupus, leukemia, lymphoma, and sarcoidosis.
• It is usually reversible if the kidney damage is not severe.
• Treatment consists of withdrawal of offending drugs, treatment of infection, and dialysis in cases of very poor kidney function.

Acute tubular necrosis: The kidney tubules are damaged and do not function normally. Tubular necrosis is usually the end result from the other causes of acute renal failure. The tubules are delicate structures that handle much of the kidney's filtration function. When there is necrosis, the cells that form the tubules become dysfunctional and "die."

• This condition accounts for 90% of cases of primary acute kidney failure.
• Causes include shock (decreased blood supply to the kidneys), drugs (especially antibiotics) and chemotherapy agents, toxins and poisons, and dyes used in certain kinds of X-rays.
• Some people produce much less urine than usual. Other symptoms of acute tubular necrosis include tiredness, swelling, lethargy, nausea, vomiting, abdominal pain, kidney pain, loss of appetite, and rash. Sometimes there are no symptoms.
• Treatment depends on the cause of the damage and may consist of discontinuing problem medications, replenishing body fluids, and improving blood flow to the kidney. A diuretic may be given to increase urine production if the total body water level is too high. Medications may be given to correct blood chemistry imbalances.
• If there is no recovery of the patient's kidneys and these treatments do not sufficiently substitute for the lost kidney function, the patient will need regular dialysis or may be a candidate for kidney transplantation.

Polycystic kidney disease (PKD): This is a genetic disorder characterized by the growth of numerous cysts in the kidneys. PKD can enlarge the kidneys and replace much of the normal structure, resulting in reduced kidney function and leading to kidney failure.

• When PKD causes kidneys to fail, which usually happens after many years, the patient requires dialysis or kidney transplantation.
• About one-half of people with the most common type of PKD progress to kidney failure, also called end-stage renal disease (ESRD).

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