Strategies for Treatment and Prevention of Acute Renal Failure

2002 ◽  
Vol 15 (5) ◽  
pp. 392-404
Author(s):  
Mary K. Stamatakis
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Medical Condition ◽  
Extracellular Fluid ◽  
Pharmacologic Therapy ◽  
Treatment And Prevention ◽  
Life Threatening

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.

Renal disease

2018 ◽  
Author(s):  
Quentin Milner
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Renal Disease ◽  
Replacement Therapy ◽  
Impaired Renal Function ◽  
Anaesthetic Management

This chapter describes the anaesthetic management of the patient with renal disease. The topics include estimation of renal function, chronic kidney disease, renal replacement therapy (including haemodialysis), acute renal failure, and the patient with a transplanted kidney. For each topic, preoperative investigation and optimization, treatment, and anaesthetic management are described. The effects of impaired renal function on the elimination of anaesthetic drugs are discussed.

scholarly journals Total IVC Occlusion as an Unusual Cause of Acute Renal Failure After Orthotopic Liver Transplantation

2017 ◽  
Vol 102 (5-6) ◽  
pp. 227-232
Author(s):  
Annette Rebel ◽  
Laura C. Duling ◽  
Erin C. Maynard ◽  
Tyler A. Crisp ◽  
Zaki-Udin Hassan
Keyword(s):  
Liver Transplantation ◽  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Renal Replacement Therapy ◽  
Renal Dysfunction ◽  
Replacement Therapy ◽  
Orthotopic Liver Transplantation ◽  
Refractory Ascites ◽  
Intraoperative Management

Renal dysfunction before and after orthotopic liver transplantation (OLT) has significant implications for morbidity and mortality of these patients. We describe the management of a 72-year-old male patient with history of alcoholic liver cirrhosis (MELD 38) undergoing OLT. The patient presented with declining renal function prior to OLT (baseline GFR <25 mL/min) due to diuretic therapy for refractory ascites, hypovolemia postgastrointestinal bleed, and possible hepatorenal syndrome. The intraoperative management was complicated by preexisting anemia (hematocrit, 22%), unusual RBC antibody (anti-JKa) and significant surgical blood loss. To achieve surgical hemostasis, temporary clamping of the inferior vena cava (IVC) caudal to the transplanted liver was necessary. Postoperatively, the patient remained anuric despite appropriate fluid resuscitation. Renal replacement therapy was initiated to balance volume and acid-base status. A venogram on postoperative day (POD) 5 indicated a complete IVC occlusion and caval thrombectomy was performed on POD 6. After restoration of venous renal drainage, renal function improved and renal replacement therapy was weaned. Renal function indicators normalized in 8 weeks, and remained unimpaired up to 3 months post-OLT. Unintended complete obstruction of the suprarenal IVC may occur during OLT to control surgical bleeding, and should be considered as a cause for acute renal failure after liver transplant. Despite the preexisting renal dysfunction, renal function quickly improved after restoration of blood flow drainage and normalized in less than 8 weeks post obstruction.

Renal disease

2021 ◽  
pp. 191-200
Author(s):  
Quentin Milner
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Renal Disease ◽  
Replacement Therapy ◽  
Impaired Renal Function ◽  
Anaesthetic Management

This chapter describes the anaesthetic management of the patient with renal disease. The topics include estimation of renal function; chronic kidney disease; renal replacement therapy (including haemodialysis); acute renal failure, and the patient with a transplanted kidney. For each topic, pre-operative investigation and optimisation, treatment, and anaesthetic management are described. The effects of impaired renal function on the elimination of anaesthetic drugs are discussed.

Renal disease

2016 ◽  
Author(s):  
Quentin Milner
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Renal Disease ◽  
Replacement Therapy ◽  
Impaired Renal Function ◽  
Anaesthetic Management

This chapter describes the anaesthetic management of the patient with renal disease. The topics include estimation of renal function, chronic kidney disease, renal replacement therapy (including haemodialysis), acute renal failure, and the patient with a transplanted kidney. For each topic, preoperative investigation and optimization, treatment, and anaesthetic management are described. The effects of impaired renal function on the elimination of anaesthetic drugs are discussed.

Veno–venous continuous renal replacement therapy for burned patients with acute renal failure

Burns ◽  
2000 ◽  
Vol 26 (7) ◽  
pp. 638-643 ◽  
Author(s):  
Richard Tremblay ◽  
Jean Ethier ◽  
Serge Quérin ◽  
Vincent Béroniade ◽  
Pierre Falardeau ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy

scholarly journals Acute Renal Failure Requiring Renal Replacement Therapy: Unusual Presentation of Multisystem Inflammatory Syndrome in Children

2021 ◽  
Vol 57 (10) ◽  
pp. 1724-1725
Author(s):  
Rakesh K Pilania ◽  
Swati Dokania ◽  
Amber Kumar ◽  
Reyaz Ahmad ◽  
Shikha Malik ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Unusual Presentation ◽  
Inflammatory Syndrome

Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients*

2002 ◽  
Vol 30 (9) ◽  
pp. 2051-2058 ◽  
Author(s):  
Philipp G. H. Metnitz ◽  
Claus G. Krenn ◽  
Heinz Steltzer ◽  
Thomas Lang ◽  
Jürgen Ploder ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients

Continuous Hemodiafiltration in Children

PEDIATRICS ◽  
1990 ◽  
Vol 85 (5) ◽  
pp. 819-823
Author(s):  
Nancy A. Bishof ◽  
Thomas R. Welch ◽  
C. Frederic Strife ◽  
Frederick C. Ryckman
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Effective Means ◽  
Tumor Lysis Syndrome ◽  
Intermittent Hemodialysis ◽  
Tumor Lysis ◽  
Continuous Arteriovenous Hemofiltration

Continuous arteriovenous hemofiltration is a form of renal replacement therapy whereby small molecular weight solutes and water are removed from the blood via convection, alleviating fluid overload and, to a degree, azotemia. It has been used in many adults and several children. However, in patients with multisystem organ dysfunction and acute renal failure, continuous arteriovenous hemofiltration alone may not be sufficient for control of azotemia; intermittent hemodialysis or peritoneal dialysis may be undesirable in such unstable patients. Recently, the technique of continuous arteriovenous hemodiafiltration has been used in many severely ill adults. We have used continuous arteriovenous hemodiafiltration in four patients at Children's Hospital Medical Center. Patient 1 suffered perinatal asphyxia and oliguria while on extracorporeal membrane oxygenation. Patients 2 and 4 both had Burkitt lymphoma and tumor lysis syndrome. Patient 3 had septic shock several months after a bone marrow transplant. All had acute renal failure and contraindications to hemodialysis or peritoneal dialysis. A blood pump was used in three of the four patients, while spontaneous arterial flow was adequate in one. Continuous arteriovenous hemodiafiltration was performed for varying lengths of time, from 11 hours to 7 days. No patient had worsening of cardiovascular status or required increased pressor support during continuous arteriovenous hemodiafiltration. The two survivors (patients 2 and 4) eventually recovered normal renal function. Continuous arteriovenous hemodiafiltration is a safe and effective means of renal replacement therapy in the critically ill child. It may be ideal for control of the metabolic and electrolyte abnormalities of the tumor lysis syndrome.

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