Strategies for Treatment and Prevention of Acute Renal Failure

Acute renal failure (ARF) is a potentially life-threatening medical condition that often complicates the hospitalization of critically ill patients. A variety of therapeutic strategies has been studied for both preventing ischemic and nephrotoxic injury to the kidney and improving renal function in established ARF. This article summarizes the role of pharmacologic therapy in the treatment of ARF. Strategies to reduce extracellular fluid volume and preserve renal function with loop diuretics, low-dose dopamine, and renal replacement therapy will be discussed. The value of preventative therapy has increased, and identifying patients at high risk for development of ARF is critical. Modification of drug regimens, administration of less nephrotoxic medications, and volume expansion prior to nephrotoxin administration can minimize toxicity to the kidney. The search for new agents that can improve survival, decrease the need for renal replacement therapy, and hasten the recovery of renal function in ARF is ongoing.