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Right arrow Contemporary Reviews in Critical Care Medicine
(Chest. 2007;131:300-308.)
© 2007 American College of Chest Physicians

Prevention of Acute Renal Failure*

Ramesh Venkataraman, MD, FCCP and John A. Kellum, MD, FCCP

* From The CRISMA Laboratory (Clinical Research, Investigation and Systems Modeling of Acute Illness), Department of Critical Care Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA.

Correspondence to: John A. Kellum, MD, FCCP, 608 Scaife Hall, The CRISMA Laboratory, Critical Care Medicine, University of Pittsburgh, 3550 Terrace St, Pittsburgh, PA 15261; e-mail: kellumja{at}ccm.upmc.edu

Abstract

Acute renal failure (ARF) comprises a family of syndromes that is characterized by an abrupt and sustained decrease in the glomerular filtration rate. In the ICU, ARF is most often due to sepsis and other systemic inflammatory states. ARF is common among the critically ill and injured and significantly adds to morbidity and mortality of these patients. Despite many advances in medical technology, the mortality and morbidity of ARF in the ICU continue to remain high and have not improved significantly over the past 2 decades. Primary strategies to prevent ARF still include adequate hydration, maintenance of mean arterial pressure, and minimizing nephrotoxin exposure. Diuretics and dopamine have been shown to be ineffective in the prevention of ARF or improving outcomes once ARF occurs. Increasing insight into mechanisms leading to ARF and the importance of facilitating renal recovery has prompted investigators to evaluate the role of newer therapeutic agents in the prevention of ARF.

Key Words: acute renal failure • diuretics • dopamine • prevention






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