Findings from the literature support the role of older age, diabetes, underlying
renal insufficiency, and
heart failure as predisposing factors for
acute renal failure. Diabetics with baseline
renal insufficiency represent the highest risk subgroup. An association between
sepsis,
hypovolemia, and
acute renal failure is clear.
Liver failure,
rhabdomyolysis, and open-heart surgery (especially valve replacement) are clinical conditions potentially leading to
acute renal failure. Increasing evidence shows that
intraabdominal hypertension may contribute to the development of
acute renal failure. Radiocontrast and
antimicrobial agents are the most common causes of nephrotoxic
acute renal failure. In terms of prevention, avoiding nephrotoxins when possible is certainly desirable;
fluid therapy is an effective prevention measure in certain clinical circumstances. Supporting cardiac output, mean arterial pressure, and renal perfusion pressure are indicated to reduce the risk for
acute renal failure. Nonionic, isoosmolar intravenous contrast should be used in high-risk patients. Although urine output and serum
creatinine lack sensitivity and specificity in
acute renal failure, they remain the most used parameters in clinical practice.
SUMMARY: