Pharmacologic Therapies for Acute Renal Failure

Kunzendorf, Ulrich (2009) Pharmacologic Therapies for Acute Renal Failure Basic & clinical pharmacology & toxicology, 105 (Suppl. S1). p. 15.

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Acute renal failure compromises several clinical situations associated
with sudden decrease of renal function. An increasing number of clinical
studies focussing on specific types of acute renal injury (e.g. sepsis,
major surgery, and nephrotoxins) have provided further details on this
heterogeneous syndrome. Acute renal failure is common in critically ill
patients; most often multifactorial and even moderately impaired renal
function significantly worsens mortality and adds to morbidity. Preventive,
well established strategies include limiting dehydration and hypotension
by using intravenous isotonic fluids in an optimal and
individualized rate according to the patient’s needs to maintain the mean
arterial pressure. Exposure to nephrotoxins including aminoglycosids,
amphotericin, or non-ionic contrast agents should be avoided. Despite
our increasing understanding of the epidemiology and pathobiology of
acute kidney injury, generally accepted and evidence-based pharmacological
preventive or therapeutic options has not yet been established. Many
drugs (e.g. renal vasodilators, diuretics, statins, vitamin C) have been
used to prevent acute kidney injury but are not convincingly effective.
Meta-analyses consistently found that N-acetylcysteine along with hydration
decreases contrast-induced kidney failure, but the effect was heterogeneous
between the different studies. Strict control of blood glucose
with intensive insulin therapy in critically ill patients did not influence
the rate of renal failure, but significantly increased the risk of hypoglycaemia.
Some promising novel interventions to target this problem have
been tested in animal models (e.g. inhibiting apoptosis). Whether these
new approaches will extend our therapeutic repertoire in the future
remains to be seen

Document Type: Article
Additional Information: Suppl. 1463JL
Research affiliation: OceanRep > The Future Ocean - Cluster of Excellence
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Refereed: Yes
ISSN: 1742-7835
Projects: Future Ocean
Date Deposited: 11 Feb 2011 12:14
Last Modified: 31 May 2016 14:46

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