Acute Renal Failure

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.