Advertisement

Acute Renal Failure

  • Paul Ellis Marik

Abstract

Acute renal failure (ARF) is a common and serious complication in seriously ill hospitalized patients. Indeed, the mortality of ARF in ICU patients has remained in excess of 50% despite improvements in renal-replacement therapy and aggressive supportive care. It is therefore essential that all efforts be made to avoid this complication; i. e., aggressive fluid resuscitation and avoidance of potentially nephrotoxic drugs (especially aminoglycosides and contrast media). The therapeutic intervention of choice in patients with oliguria is fluid resuscitation and not furosemide (see Chapter 17). Furthermore, while low-dose dopamine increases renal blood flow and urine output in patients with normal renal function, dopamine does not improve renal function, reduce the need for dialysis, or alter the course of ARF in critically ill patients. In addition, studies have demonstrated that furosemide is of no value in modifying azotemia, reducing the need for dialysis, altering the time to recovery of renal function, reducing hospital stay, or impacting survival in established ARF. In patients who remain oliguric/anuric after adequate fluid resuscitation, it is important to exclude urinary tract obstruction (and urinary catheter obstruction), as this is an immediately reversible cause of ARF.

Keywords

Acute Renal Failure Mean Arterial Pressure Continuous Renal Replacement Therapy Acute Tubular Necrosis Acute Interstitial Nephritis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Selected References

  1. 1.
    Barrett BJ, Carlisle EJ. Meta-analysis of the relative nephrotoxicity of high- and low-osmolality iodinated contrast media. Radiology. 1993;188:171–178.PubMedGoogle Scholar
  2. 2.
    Chertow G, Sayegh M, Allgren RL. Is the administration of dopamine associated with adverse or favorable outcomes in acute renal failure. Am J Med. 1996;101:49–53.PubMedCrossRefGoogle Scholar
  3. 3.
    Groeneveld ABJ, Tra DD, Van der Meulen J. Acute renal failure in the medical intensive care unit: predisposing, complicating factors and outcome. Nephron. 1991;59:602–610.PubMedCrossRefGoogle Scholar
  4. 4.
    Marik PE, Iglesias J. Low-dose dopamine does not prevent acute renal failure in patients with septic shock and oliguria. NORASEPT II Study investigators. Am J Med. 1999;107:387–390.PubMedCrossRefGoogle Scholar
  5. 5.
    Russo D, Memoli B, Andreucci VE. The place of loop diuretics in the treatment of acute and chronic renal failure. Clin Nephrol. 1992;38(suppl 1):S69-S73.PubMedGoogle Scholar
  6. 6.
    Shilliday IR, Quinn KJ, Allison ME. Loop diuretics in the management of acute renal failure: a prospective, double-blind, placebo-controlled, randomized study. Nephrol Dial Transplant. 1997;12:2592–2596.PubMedCrossRefGoogle Scholar
  7. 7.
    Solomon R, Werner C, Mann D, D’Elia J, Silva P. Effects of saline, mannitol, and furosemide to prevent acute decreases in renal function induced by radiocontrast agents. N Engl J Med. 1994;331:1416–1420.PubMedCrossRefGoogle Scholar
  8. 8.
    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 Eng J Med 2000;343:80–4.CrossRefGoogle Scholar
  9. 9.
    Younathan CM, Kaude JV, Cook MD, Shaw GS, Peterson JC. Dialysis is not indicated immediately after administration of nonionic contrast agents in patients with end-stage renal disease treated by maintenance dialysis. Am J Roentgenol. 1994;163:969–971.Google Scholar

Copyright information

© Springer-Verlag New York, Inc. 2001

Authors and Affiliations

  • Paul Ellis Marik
    • 1
  1. 1.Critical Care MedicineMercy Hospital of PittsburghPittsburghUSA

Personalised recommendations