Acute Renal Failure: Therapy
Azra Sehic MD1
Russell W. Chesney MD1
1 Division of Nephrology, Department of Pediatrics, University of Tennessee College of Medicine, Memphis, TN. This work was supported by NIH Grants DK 37232 and HD and The Crippled Children's Foundation Research Center, Memphis, TN.
General Therapy for Acute Renal Failure In most cases of ARF without complication, treatment should be conservative and largely supportive. It requires careful and precise management. All patients will require close monitoring, many of them within intensive care settings.
Supportive care includes stabilizing the patient, monitoring input and output strictly weighing daily, determining electrolyte values frequently, preventing sepsis via reducing the number of intravenous lines and removing an indwelling urinary catheter, culturing periodically, and using antibiotics when indicated clinically. It is important to adjust medication dosage according to renal function and to avoid nephrotoxins whenever possible. Because serum creatinine values increase daily, it is best to calculate drug doses based on GFR <10 mL/min per 1.73 m2, rather than on the serum creatinine level.
Conservative therapy may be symptomatic or specific. Symptomatic therapy consists of treating the underlying prerenal conditions that led to renal failure; maintaining the fluid and electrolyte balance; initiating therapy for complications such as hyperkalemia, hypertension, acidosis, and infection; and instituting appropriate nutrition. Specific therapy consists of using medications for specific underlying causes and may include steroids (conventional or high-dose pulse steroid therapy) and other immunosuppressive agents, anticoagulation agents, plasmapheresis, or intravenous immunoglobulin.
THERAPY FOR PRERENAL FAILURE
Rapid volume replacement and treatment of the underlying condition that resulted in prerenal failure are the cornerstones of therapy.
