Acute Renal Failure - Intrinsic Renal Failure & Its Consequences

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  • 0:37 Intrinsic Renal Failure
  • 1:49 Causes
  • 3:41 The Result
  • 6:18 Diagnosis & Treatment
  • 7:23 Lesson Summary
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Lesson Transcript
Instructor: Artem Cheprasov

Artem has a doctor of veterinary medicine degree.

This lesson will focus on what intrinsic renal failure means, what can cause it, and how it differs from pre-renal failure. We'll also discuss some additional diagnostic and treatment strategies of acute renal failure not covered in other lessons on this topic.

Sick Kidneys

Sick puppies, sick people, and sick kidneys are all alike in the sense that they all don't work very well. And just like with people and puppies, there are a ton of reasons as to why the kidneys may be sick. Sometimes, it's an infection by bacteria. Other times, it's a genetic disorder.

Whatever the cause of the sick kidneys, they can end up failing. The causes of acute, or sudden onset, kidney failure will be covered in this lesson. More specifically, we'll cover the cause of acute renal failure as a result of intrinsic renal (or kidney) failure.

Intrinsic Renal Failure

Intrinsic renal failure refers to a condition in which the kidneys stop functioning due to internal kidney disease. What I'm trying to say here is that the kidneys don't fail as a result of prerenal causes (covered in another lesson), such as dehydration. Nor do they fail as a result of postrenal causes (also covered in another lesson), such as a stone blocking the outflow of urine. They fail because the kidneys themselves are diseased.

The functional unit of the kidney, the one responsible for filtering your blood and modifying the composition of urine, is known as the nephron. There are millions of these nephrons in each kidney, and each one has a little filter, known as a glomerulus, which (obviously) filters the blood. Connected to each nephron's glomerulus is the nephron's renal tubule. This long tube helps to modify the composition of urine as it flows through the kidneys.

The connective tissue surrounding and enclosing the nephrons of the kidney is known as the renal interstitium, and it also has an important role in kidney function.

Causes of Intrinsic Renal Failure

If the nephrons or renal interstitium are damaged or sick, this can cause acute renal failure. Causes for this include:

  • Toxins, such as certain chemotherapy agents. It's essentially a poison pill for your kidneys.
  • Glomerulonephritis, the inflammation of the kidney's glomeruli due to any number of causes. Just imagine burning the filter in your home's air system. That's what glomerulonephritis does. It burns holes in the glomerulus, the filter, and therefore causes kidney dysfunction.
  • Another cause is pyelonephritis, infection of the kidneys. Just like an upper respiratory infection can cause you to get sick, so can infection cause your kidneys to malfunction and feel sick.
  • Furthermore, inadequate oxygen delivery as a result of prerenal failure can cause intrinsic renal failure. If not enough oxygen is delivered to the kidneys, they suffocate to death, and this causes the cells of the kidneys to die. If the cells die, they obviously can't work very well and fail. It's just like shutting off the oxygen tank to the kidneys in this case. All of this can lead to acute tubular necrosis, which is basically the death of the kidney's tubules.
  • Furthermore, autoimmune disease that attacks the kidneys directly can cause intrinsic renal failure. This is when your own body damages your kidneys. Just like some people for some reason enjoy hurting themselves, here, the immune system does this automatically for you, but internally so.

Again, any of these causes, and much more, result in decreased kidney function, especially in their ability to filter and excrete dangerous waste products.

The Result of Intrinsic Renal Failure

Many of these processes lead to the same consequences as per prerenal failure we discussed in another lesson. This includes metabolic acidosis, which is where the body becomes filled with dangerous acid, and hyperkalemia, which is an increase in potassium ions in the blood that can cause the heart to stop beating.

In order for doctors to figure out if the similar consequences of acute renal failure are prerenal, renal, or postrenal in nature, tests are run. Finding out the cause of acute renal failure is important for directing treatment strategies more appropriately to the underlying cause.

First of all, during intrinsic renal failure, the kidneys are receiving an adequate amount of blood (unless it's caused by prerenal failure). Because the kidneys are receiving adequate amounts of blood, they do not activate something known as the renin-angiotensin-aldosterone system, or RAAS. RAAS tells the kidneys to reabsorb sodium and water back into the body to maintain blood volume. But because our blood volume is just fine, RAAS stays silent. This, coupled with the fact that the kidneys can't reabsorb things properly anyways when they're sick, leads to water and sodium to leak into the urine more so than normal. This results in more dilute urine and higher amounts of sodium excretion in the urine. This is directly opposite of what happens in prerenal failure.

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