Items in AFP with MESH term: Kidney Failure, Acute
Management of Acute Renal Failure - Article
ABSTRACT: Acute renal failure is present in 1 to 5 percent of patients at hospital admission and affects up to 20 percent of patients in intensive care units. The condition has prerenal, intrarenal, and postrenal causes, with prerenal conditions accounting for 60 to 70 percent of cases. The cause of acute renal failure usually can be identified through an appropriate history, a physical examination, and selected laboratory tests. The initial laboratory evaluation should include urinalysis, a determination of the fractional excretion of sodium, a blood urea nitrogen to creatinine ratio, and a basic metabolic panel. Management includes correction of fluid and electrolyte levels; avoidance of nephrotoxins; and kidney replacement therapy, when appropriate. Several recent studies support the use of acetylcysteine for the prevention of acute renal failure in patients undergoing various procedures. The relative risk of serum creatinine elevation was 0.11 in patients undergoing radiocontrast-media procedures (absolute risk reduction: 19 percent) and 0.33 in patients undergoing coronary angiography (absolute risk reduction: 8 percent). In patients pretreated with sodium bicarbonate before radiocontrast-media procedures, the relative risk of serum creatinine elevation was 0.13 and the absolute risk reduction was 11.9 percent. Dopamine and diuretics have been shown to be ineffective in ameliorating the course of acute renal failure.
Drug-Induced Nephrotoxicity - Article
ABSTRACT: Drugs are a common source of acute kidney injury. Compared with 30 years ago, the average patient today is older, has more comorbidities, and is exposed to more diagnostic and therapeutic procedures with the potential to harm kidney function. Drugs shown to cause nephrotoxicity exert their toxic effects by one or more common pathogenic mechanisms. Drug-induced nephrotoxicity tends to be more common among certain patients and in specific clinical situations. Therefore, successful prevention requires knowledge of pathogenic mechanisms of renal injury, patient-related risk factors, drug-related risk factors, and preemptive measures, coupled with vigilance and early intervention. Some patient-related risk factors for drug-induced nephrotoxicity are age older than 60 years, underlying renal insufficiency (e.g., glomerular filtration rate of less than 60 mL per minute per 1.73 m2), volume depletion, diabetes, heart failure, and sepsis. General preventive measures include using alternative non-nephrotoxic drugs whenever possible; correcting risk factors, if possible; assessing baseline renal function before initiation of therapy, followed by adjusting the dosage; monitoring renal function and vital signs during therapy; and avoiding nephrotoxic drug combinations.
Treatment of Ethylene Glycol Poisoning - Article
ABSTRACT: Ingestion of ethylene glycol may be an important contributor in patients with metabolic acidosis of unknown cause and subsequent renal failure. Expeditious diagnosis and treatment will limit metabolic toxicity and decrease morbidity and mortality. Ethylene glycol poisoning should be suspected in an intoxicated patient with anion gap acidosis, hypocalcemia, urinary crystals, and nontoxic blood alcohol concentration. Fomepizole is a newer agent with a specific indication for the treatment of ethylene glycol poisoning. Metabolic acidosis is resolved within three hours of initiating therapy. Initiation of fomepizole therapy before the serum creatinine concentration rises can minimize renal impairment. Compared with traditional ethanol treatment, advantages of fomepizole include lack of depression of the central nervous system and hypoglycemia, and easier maintenance of effective plasma levels.
Acute Renal Failure - Clinical Evidence Handbook