Skip to main content
Log in

Clinical acute renal failure diagnosis and management

  • Original Article
  • Published:
Comprehensive Therapy

Abstract

Acute renal failure (ARF)_is frequently encountered in the hospitalized setting. In this article, we discuss the etiology, pathogenesis, preventative therapies, and renal replacement strategies in patients with acute tubular necrosis, the most common form of hospitalized ARF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Thadhani R, Pascual M, Bonventre JV. Acute renal failure. N Engl J Med 1996;334(22):1448–1460.

    Article  PubMed  CAS  Google Scholar 

  2. de Mendonca A, Vincent JL, Suter PM, et al. Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med 2002;26(7):915–921.

    Google Scholar 

  3. Poole B, Schrier RW. Acute Renal Failure. In: Textbook of Critical Care (5th ed.) Fink M, Abraham E, Vincent J, Kochanek P, eds.). Elsevier Saunders, Philadelphia, 2005, 1039–1150.

    Google Scholar 

  4. Hou SH, Bushinsky DA, Wish JB, Cohen JJ, Harrington JT. Hispitalacquired renal insufficiency: a prospective study. Am J Med 1983;74(2):243–248.

    Article  PubMed  CAS  Google Scholar 

  5. Kaufman J, Dhakal M, Patel B, Hamburger R. Community-acquired acute renal failure. Am J Kidney Dis 1991;17(2):191–198.

    PubMed  CAS  Google Scholar 

  6. Blantz RC. Pathophysiology of pre-renal azotemia. Kidney Int 1998;53(2):512–523.

    Article  PubMed  CAS  Google Scholar 

  7. Esson ML, Schrier RW. Diagnosis and treatment of acute tubular necrosis. Ann Intern Med 2002;137(9):744–752.

    PubMed  Google Scholar 

  8. Kobrin SM. Acute poststreptococcal glomerulonephritis and other bacterial infection-related glomerulonephritis. In: Diseases of the Kidney and Urinary Tract (7th ed.) (Schrier RW ed.). Lippincott, Williams & Wilkins, Philadelphia, 2001, 1617–1632.

    Google Scholar 

  9. Behrend T, Miller SB. Acute renal failure in the cardiac care unit: etiologies, outcomes, and prognostic factors. Kidney Int 1999;56(1):238–243.

    Article  PubMed  CAS  Google Scholar 

  10. Feest TG, Round A, Hamad S. Incidence of severe acute renal failure in adults: results of a community based study. BMJ 1993;306(6876):481–483.

    PubMed  CAS  Google Scholar 

  11. Liano F, Junco E, Pascual J, Madero R, Verde E. The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings. The Madrid Acute Renal Failure Study Group. Kidney Int Suppl 1998;66:S16-S24.

    PubMed  CAS  Google Scholar 

  12. Shapiro SR, Bennett AH. Recovery of renal function after prolonged unilateral ureteral obstruction. J Urol 1976;115(2):136–140.

    PubMed  CAS  Google Scholar 

  13. Schrier RW, Wang W, Poole B, Mitra A. Acute renal failure: definitions, diagnosis, pathogenesis, and therapy. J Clin Invest 2004;114(1):5–14.

    Article  PubMed  CAS  Google Scholar 

  14. Kribben A, Wieder ED, Wetzels JF, et al. Evidence for role of cytosolic free calcium in hypoxia-induced proximal tubule injury. J Clin Invest 1994;93(5):1922–1929.

    Article  PubMed  CAS  Google Scholar 

  15. Edelstein CL, Wieder ED, Yaqoob MM, et al. The role of cysteine proteases in hypoxia-induced rat renal proximal tubular injury. Proc Natl Acad Sci USA 1995;92(17):7662–7666.

    Article  PubMed  CAS  Google Scholar 

  16. Schnermann J, Homer W, Smith Award lecture. The juxtaglomerular apparatus: from anatomical peculiarity to physiological relevance. J Am Soc Nephrol 2003;14(6):1681–1694.

    Article  PubMed  Google Scholar 

  17. Carvounis CP, Nisar S, Guro-Razuman S. Significance of the fractional excretion of urea in the differential diagnosis of acute renal failure. Kidney Int 2002;62(6):2223–2229.

    Article  PubMed  CAS  Google Scholar 

  18. Levy EM, Viscoli CM, Horwitz RL. The effect of acute renal failure on mortality. A cohort analysis. JAMA 1996;275(19):1489–1494.

    Article  PubMed  CAS  Google Scholar 

  19. Bonomini V, Stefoni S, Vangelista A. Long-term patient and renal prognosis in acute renal failure. Nephron 1984;36(3):169–172.

    Article  PubMed  CAS  Google Scholar 

  20. Kjellstrand CM, Ebben J, Davin T. Time of death, recovery of renal function, development of chronic renal failure and need for chronic hemodialysis in patients with acute tubular necrosis. Trans Am Soc Artif Intern Organs 1981;27:45–50.

    PubMed  CAS  Google Scholar 

  21. Druml W, Lax F, Grimm G, Schneeweiss B, Lenz K, Laggner AN. Acute renal failure in the elderly 1975–1990. Clin Nephrol 1994;41(6):342–349.

    PubMed  CAS  Google Scholar 

  22. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute Dialysis Quality Initiative workgroup. Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;8(4):R204-R212.

    Article  PubMed  Google Scholar 

  23. Herget-Rosenthal S, Marggraf G, Husing J, et al. Eary detection of acute renal failure by serum cystatin C. Kidney Int 2004;66(3):1115–1122.

    Article  PubMed  CAS  Google Scholar 

  24. Aspelin P, Aubry P, Fransson SG, et al. Nephrotoxic effects in high-risk patients undergoing angiogrphy. N Engl J Med 2003;348(6):491–499.

    Article  PubMed  CAS  Google Scholar 

  25. Trivedi HS, Moore H, Nasr S, et al. A randomized prospective trial to assess the role of saline hydration on the development of contrast nephrotoxicity. Nephron Clin Pract 2000;93(1):C29-C34.

    Article  Google Scholar 

  26. Mueller C, Buerkle G, Buettner HJ, et al. Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med 2002;162(3):329–336.

    Article  PubMed  CAS  Google Scholar 

  27. Merten GJ, Burgess WP, Gray LV, et al. Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA 2004;291(19):2328–2334.

    Article  PubMed  CAS  Google Scholar 

  28. Tepel M, van der Giet M, Schwarzfeld C, Laufer U, Liermann D, Zidek W. Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med 2000;343(3):180–184.

    Article  PubMed  CAS  Google Scholar 

  29. MA IW, Hladunewich M. Does the prophylactic use of N-acetyl-cysteine prevent contrast nephropathy in patients with renal insufficiency? Can Med Assoc J 2004;170(8):1231.

    Article  Google Scholar 

  30. Nallamothu BK, Shojania KG, Saint S, et al. Is acetylcysteine effective in preventing contrast-related nephropathy? A meta-analysis. Am J Med 2004;117(12):938–947.

    Article  PubMed  CAS  Google Scholar 

  31. Misra D, Leibowitz K, Gowda RM, Shapiro M, Khan IA. Role of N-acetylcysteine in prevention of contrast-induced nephropathy after cardiovascular procedures: a meta-analysis. Clin Cardiol 2004;27(11):607–610.

    PubMed  Google Scholar 

  32. Bagshaw SM, Ghali WA. Acetylcysteine for prevention of contrast-induced nephropathy after intravascular angiography: a systematic review and meta-analysis. BMC Med 2004;2(1):38.

    Article  PubMed  CAS  Google Scholar 

  33. Kshirsagar AV, Poole C, Mottl A, et al. N-acetylcysteine for the prevention of radiocontrast induced nephropathy: a meta-analysis of prospective controlled trials. J Am Soc Nephrol 2004;15(3):761–769.

    Article  PubMed  CAS  Google Scholar 

  34. Alonso A, Lau J, Jaber BL, Weintraub A, Sarnak AJ. Prevention of radiocontrast nephropathy with N-acetylcysteine in patients with chronic kidney disease: a meta-analysis of randomized, controlled trials. Am J Kidney Dis 2004;43(1):1–9.

    Article  PubMed  CAS  Google Scholar 

  35. Isenbarger DW, Kent SM, O'Malley PG. Meta-analysis of randomized clinical trials on the usefulness of acetylcysteine for prevention of contrast nephropathy. Am J Cardiol 2003;92(12):1454–1458.

    Article  PubMed  CAS  Google Scholar 

  36. Birck R, Krzossok S, Markowetz F, Schnulle P, van der Woude FJ, Braun C. Acetylcysteine for prevention of contrast nephropathy: meta-analysis. Lancet 2003;362(9384):598–603.

    Article  PubMed  CAS  Google Scholar 

  37. Stone GW, McCullough PA, Tumlin JA, et al. Fenoldopam mesylate for the prevention of contrast-induced nephropathy: a randomized controlled trial. JAMA 2003;290(17):2284–2291.

    Article  PubMed  CAS  Google Scholar 

  38. Marenzi G, Marana I, Lauri G, et al. The prevention of radiocontrast-agent-induced nephropathy by hemofiltration. N Engl J Med 2003;349(14):1333–1340.

    Article  PubMed  CAS  Google Scholar 

  39. Gambaro G, Bertaglia G, Puma G, D'Angelo A. Diuretics and dopamine for the prevention and treatment of acute renal failure: a critical reappraisal. J Nephrol 2002;15(3):213–219.

    PubMed  CAS  Google Scholar 

  40. Bellomo R, Chapman M, Finfer S, Hickling K, Myburgh J. Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Lancet 2000;356(9248):2139–2143.

    Article  PubMed  CAS  Google Scholar 

  41. Kellum JA, M Decker J. Use of dopamine in acute renal failure: a meta-analysis. Crit Care Med 2001;29(8):1526–1531.

    Article  PubMed  CAS  Google Scholar 

  42. Holmes CL, Walley KR. Bad medicine: low-dose dopamine in the ICU. Chest 2003;123(4):1266–1275.

    Article  PubMed  CAS  Google Scholar 

  43. Anderson RJ, Linas SL, Burns AS, et al. Nonoliguric acute renal failure. N Engl J Med 1977;296(20):1134–1138.

    Article  PubMed  CAS  Google Scholar 

  44. Gubern JM, Sancho JJ, Simo J, Sitges-Serra A. A randomized trial on the effect of mannitol on postoperative renal function in patients with obstructive jaundice. Surgery 1988;103(1):39–44.

    PubMed  CAS  Google Scholar 

  45. Shilliday IR, Quinn KJ, Allison ME. Loop diuretics in the management of acute renal failure: a prospective, double-blind, placebo-controlled, randomized study. Neprhol Dial Transplant 1997;12(12):2592–2596.

    Article  CAS  Google Scholar 

  46. Mehta RL, Pascual MT, Soroko S, Chertow GM, PICARD study group. Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA 2002;288(20):2547–2553.

    Article  PubMed  CAS  Google Scholar 

  47. Cantarovich F, Rangoonwalla B, Lorenz H, et al. High-dose furosemide for established ARF: a prospective, randomized, doubleblind, placebo-controlled, multicenter trial. Am J Kidney Dis 2004;44(3):402–409.

    PubMed  CAS  Google Scholar 

  48. Schneeweiss B, Graninger W, Stockenhuber F, et al. Energy metabolism in acute and chronic renal failure. Am J Clin Nutr 1990;52(4):596–601.

    PubMed  CAS  Google Scholar 

  49. Druml W. Nutritional management of acute renal failure. J Ren Nutr 2005;15(1):63–70.

    Article  PubMed  Google Scholar 

  50. Chima CS, Meyer L, Hummell AC, et al. Protein catabolic rate in patients with acute renal failure on continuous arteriovenous hemofiltration and total parenteral nutrition. J Am Soc Nephrol 1993;3(8):1516–1521.

    PubMed  CAS  Google Scholar 

  51. Gillum DM, Dixon BS, Yanover MJ, et al. The role of intensive dialysis in acute renal failure. Clin Nephrol 1986;25(5):249–255.

    PubMed  CAS  Google Scholar 

  52. Mehta R, Mcdonald B, Gabbai F, et al. Continuous versus intermitent dialysis for acute renal failure (ARF) in the ICU: results from a randomized multicenter trial (Abstract). J Am Soc Nephrol 1996;7:A1044.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Robert W. Schrier MD.

Additional information

The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors do discuss the use of generic medications.

About this article

Cite this article

Mitra, A., Zolty, E., Wang, W. et al. Clinical acute renal failure diagnosis and management . Compr Ther 31, 262–269 (2005). https://doi.org/10.1385/COMP:31:4:262

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1385/COMP:31:4:262

Keywords

Navigation