Approximately 70% of community-acquired cases of acute kidney injury are attributed to pre-renal causes. In most of these cases, the underlying kidney function may be normal, but decreased renal perfusion associated with low intravascular volume or decreased arterial pressure can determine a reduced glomerular filtration rate (GFR). Autoregulatory mechanisms can partially compensate renal perfusion reduction in order to maintain GFR. In patients with pre-existing chronic kidney disease, however, these mechanisms are impaired, and the susceptibility to develop acute-on-chronic renal failure is higher.
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