Acute renal failure (ARF) is defined as a rapid or abrupt depression of glomerular filtration rate (GRF) sufficient to cause the retention of nitrogenous waste products (BUN and serum creatinine). Although ARF may accompany a number of specific diseases and disorders, most commonly it results from an ischemic insult, often in association with a nephrotoxic drug that profoundly disrupts tubular cell function and structure. ARF is a common disorder. In two prospective studies (1,2), it was found to develop in 2% to 5% of patients admitted to hospital. In selected groups of patients, e.g., those with cardiopulmonary bypass surgery (3,4), ruptured aortic aneurysm (5), or rhabdomyolysis (6,7), the incidence of ARF may be substantially higher. ARF often develops as a complication of therapy or diagnostic procedures; thus, it frequently is an iatrogenic disorder (8). Furthermore, the development of ARF confers a greatly increased risk of dying in hospital (2), and this risk has not been appreciably reduced over the past 20 years, despite the technological advances in renal replacement therapies (9). A number of factors may explain this discouraging statistic. Nevertheless, the fact remains that ARF is a deadly disorder; the most effective treatment today is primary prevention. In this chapter, current concepts of pathogenesis, treatment, and prevention of ARF will be reviewed. The primary focus will be on ischemic and nephrotoxic ARF. For information about ARF associated with specific renal and systemic diseases and disorders, the interested reader should consult the relevant chapter(s) in this book.


Acute Renal Failure Atrial Natriuretic Peptide Acute Tubular Necrosis Proximal Tubular Cell Renal Hypoperfusion 
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Copyright information

© Springer Science+Business Media New York 1998

Authors and Affiliations

  • George J. Kaloyanides
    • 1
  1. 1.Division of Nephrology and Hypertension Health Scinences Center, CST15-020State University of New York at Stony BrookStony BrookUSA

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