Prerenal acute renal failure

Prerenal acute renal failure (ARF) occurs when a sudden reduction in blood flow to the kidney (renal hypoperfusion) causes a loss of kidney function. In prerenal acute renal failure, there is nothing wrong with the kidney itself.

Prerenal acute renal failure is the most common type of acute renal failure, accounting for about 55% of all acute renal failure cases.1 It can be a complication of almost any disease, condition, or medication that causes a decrease in the normal amount of blood and fluid in the body, low blood pressure, reduced blood output by the heart, or sudden narrowing of the blood vessels inside or outside the kidneys.

Causes of prerenal acute renal failure include:

  • Severe blood loss and low blood pressure related to major cardiac or abdominal surgery, severe infection (sepsis), or injury.
  • Medications that interfere with the blood supply to the kidneys. Medications used to control high blood pressure, such as ACE inhibitors, and common pain medicines (NSAIDs), such as aspirin and ibuprofen, commonly cause prerenal acute renal failure in people who already have an increased risk for kidney problems.
  • Severe dehydration caused by excessive fluid loss.
  • Severe burns.
  • Pancreatitis and liver diseases, such as cirrhosis, that create fluid shifts in the abdomen.
  • Blood clots (thrombosis) in the renal artery.

Treatment focuses on correcting the cause of the prerenal acute renal failure. Depending on the cause, the condition often reverses itself within a couple of days once normal blood flow to the kidneys has been restored. However, if it is not reversed or treated successfully and quickly, prerenal acute renal failure can cause tissue death in the kidneys and lead to intrinsic (intrarenal) acute renal failure.


  1. Liu KD, Chertow GM (2008). Acute renal failure. In AS Fauci et al., eds., Harrison's Principles of Internal Medicine, 17th ed., vol. 2, pp. 1752–1761. New York: McGraw-Hill.

Last Updated: June 3, 2009

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