Intrinsic: Differential

• Vascular (large and small vessel)

• • Renal artery obstruction (thrombosis, emboli, dissection, vasculitis)
  • Renal vein obstruction (thrombosis)
  • Microangiopathy (TTP, hemolytic uremic syndrome [HUS], DIC, preeclampsia)
  • Malignant hypertension
  • Scleroderma renal crisis
  • Transplant rejection
  • Atheroembolic disease

• Interstitial

• • Drugs (penicillins, cephalosporins, NSAIDs, proton-pump inhibitors, allopurinol, rifampin, indinavir, mesalamine, sulfonamides)
  • Infection (pyelonephritis, viral nephritides)
  • Systemic disease (Sjogren syndrome, sarcoid, lupus, lymphoma, leukemia, tubulonephritis, uveitis)

• Tubular

• • Ischemi
  • Cytotoxic:
  • Heme pigment (rhabdomyolysis, intravascular hemolysis)
  • Crystals (tumor lysis syndrome, seizures, ethylene glycol poisoning, megadose vitamin C, acyclovir, indinavir, methotrexate)
  • Drugs (aminoglycosides, lithium, amphotericin B, pentamidine, cisplatin, ifosfamide, radiocontrast agents

• Glomerular

• • Anti–glomerular basement membrane (GBM) disease (Goodpasture syndrome)
  • Anti–neutrophil cytoplasmic antibody-associated glomerulonephritis (ANCA-associated GN) (Wegener granulomatosis, Churg-Strauss syndrome, microscopic polyangiitis)
  • Immune complex GN (lupus, postinfectious, cryoglobulinemia, primary membranoproliferative glomerulonephritis)