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Diagnosed with pre-renal failure due to hormones. How is the kidney structure working?

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I do not understand my doctor, he said that there is a single most common cause for my "pre-renal failure" Is it hormones, circulation, how my kidney structures are working (or not), or some kidney mechanism?
Posted Sat, 11 Aug 2012 in Kidney Conditions
Answered by Dr. Ravi Bansal 16 hours later

Thanks for writing in.
From your standpoint, congestive heart failure remains the most common cause of pre renal failure. This is a condition where the heart cannot pump enough blood to feed the rest of the organs. In congestive heart failure, the person would typically have breathlessness on walking, swelling in the legs and around the feet and several other symptoms as well.
Because this condition reduces the blood supply to the kidney, kidney is not able to get the required blood flow to produce adequate urine and throw out the waste products. This leads to a condition called pre renal failure. Normally 20% of the total cardiac output goes to the kidney.
In congestive heart failure, we have a condition where several mechanisms like hormones (like angiotensin II, aldosterone), reduced blood supply , the sympathetic nervous system work together to produce this condition.
To help you further and to know the extent of damage, it is important to know in detail your history and also lab results.
Awaiting your reply

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Follow-up: Diagnosed with pre-renal failure due to hormones. How is the kidney structure working? 6 hours later
Doctor Bansal:
I really appreciate your prompt reply. So are you saying that pre renal failure no matter what other issues may be going on is due to the reduction in renal perfusion, firstly and most commonly, or is it that renal auto-regulatory mechanisms kick in first to bring about pre renal failure, or does it have to do most commonly with less aldosterone, or the narrowing of afferent arterioles? I am doing lots of research to find out what is the best for me, but I really think that I first need to know what caused this mainly.
Answered by Dr. Ravi Bansal 10 hours later

I appreciate your efforts.

Yes, Prerenal failure is due to reduction in renal perfusion.

Auto-regulatory mechanism would be triggered only if the renal ischemia is sensed by specialized cells of the afferent arteriole and renal tissue. Renin angiotensin system and sympathetic nervous system play important role in the management of renal perfusion.

I will give you an example. If there is sudden loss of blood volume, or a decrease in blood pressure; body would first try to increase blood flow to the brain. So blood will be diverted from other organs. When that happens renal auto regulation will try to maintain renal perfusion to some extent by dilating the afferent arterioles supplying the kidney tissue; but if the primary insult remains then ultimately the kidney would go into shutdown.

The pathophysiology for prerenal failure would differ on the basis of the primary problem that initiated the event. I think your treating physician is the best person to guide you for treatment.

Hope this helps. Let me know if you have any more queries.

Above answer was peer-reviewed by
Follow-up: Diagnosed with pre-renal failure due to hormones. How is the kidney structure working? 2 hours later
OK, thank yo so much for shedding light into this issue. I will see my doctor, but one more question before I close, do you think having prerenal failure would definitively make dialysis inevitable? I mean would a kidney transplant be a solution to prerenal failure?
Answered by Dr. Ravi Bansal 52 minutes later

Prerenal failure is generally reversible - that means you do not need transplant if kidney starts working again.

Once the cause has been treated (provided it is amenable to treatment) the kidney should regenerate the damaged tubules and start working. But in case the kidney damage has become permanent, i.e. the prerenal illness has caused cortical necrosis or permanent damage then dialysis/transplant may be needed.

Hope I have answered all your queries to your satisfaction. I will be glad to assist you further in case you have more follow up.
If all your queries are answered, please close this discussion. Any feed backs are appreciated.

Above answer was peer-reviewed by
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