• Acute renal failure is a syndrome, not a nosological diagnosis. Its presence demands that an etiological diagnosis be established. The best clinical approach to an etiological diagnosis is achieved by considering prerenal, parenchymal, and postrenal causes.
• Prerenal causes of renal failure are responsible for the vast majority of cases seen in the intensive care unit.
• An accurate history, a focused clinical examination, microscopic examination of urine, and a renal ultrasound examination are usually sufficient to establish the correct diagnosis in the vast majority of cases.
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