23rd June 2023

Pre-renal AKI

A pre-renal AKI is caused by a reduction in renal blood flow. Causes include:

• Reduced actual circulating volume:
  • Haemorrhage
  • Dehydration
  • Excess gastrointestinal or urinary losses, e.g. osmotic diuresis secondary to hyperglycaemia
  • Third-space loss of fluid, e.g. pancreatitis
  • Burns
• Reduced apparent circulating volume – may not necessarily be overall volume depletion, but effective circulating volume and, therefore, renal perfusion reduced for another reason
  • Peripheral vasodilatation e.g. sepsis
  • Reduced cardiac output
• Intrarenal haemodynamic changes
  • Non-steroidal anti-inflammatory drugs (inhibition of prostaglandin synthesis, reducing afferent artery dilatation)
  • ACE inhibitors (oppose efferent artery vasoconstriction, reducing perfusion pressure)