Acute renal failure is characterized by a deterioration of renalfunction over a period of hours to days, resulting in the failureof the kidney to excrete nitrogenous waste products and to maintainfluid and electrolyte homeostasis. In the past five decades,several important causes of acute renal failure and the pathophysiologicmechanisms that underlie renal dysfunction have come to be understood.In this article we highlight the epidemiology, general causes,and evaluation of acute renal failure in adults. We then expandon the pathophysiology of ischemic acute renal failure and discussthe rationale for both current and future therapies. . . . [Full Text of this Article]
Background and Epidemiology
Causes of Acute Renal Failure
Prerenal Causes
Postrenal Causes
Intrinsic Causes
Risk Factors, Morbidity, and Mortality
Diagnostic Evaluation
History Taking and Physical Examination
Urine Evaluation
Blood Tests
Evaluation of Obstruction
Role of Renal Biopsy in Acute Renal Failure
Pathophysiology of Ischemic Acute Renal Failure and Rationale for Therapies
Vascular Factors and Therapy with Vasodilators
Dopamine
Calcium-Channel Blockers
Natriuretic Peptides
Medullary Hypoxia
Tubular-Cell Injury
Structural Changes
Osmotic Agents and Diuretics
Biochemical Changes
Calcium
Reactive oxygen species
Purine depletion
Phospholipases
Apoptosis
Acute Renal Failure in Transplant Recipients
Role of Growth Factors in Recovery from Ischemic Acute Renal Failure
Management of Acute Renal Failure
General Principles
Replacement Therapy
Source Information
From the Department of Medicine and Renal Unit (R.T., M.P., J.V.B.) and the Transplantation Unit (M.P.), Massachusetts General Hospital and Harvard Medical School; and the Harvard–Massachusetts Institute of Technology Division of Health Sciences and Technology (J.V.B.) — all in Boston.
Address reprint requests to Dr. Bonventre at Suite 4002, 149 13th St., Charlestown, MA 02129.
References
Related Letters:
Acute Renal Failure
Lindner A., Sherrard D. J., Friedman E. A., Glaser D. S., Thadhani R., Pascual M., Bonventre J. V.
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Full Text
N Engl J Med 1996;
335:1320-1322, Oct 24, 1996.
Correspondence
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Fiaschi-Taesch, N. M., Santos, S., Reddy, V., Van Why, S. K., Philbrick, W. F., Ortega, A., Esbrit, P., Orloff, J. J., Garcia-Ocana, A.
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(2003). Identification of Neutrophil Gelatinase-Associated Lipocalin as a Novel Early Urinary Biomarker for Ischemic Renal Injury. J. Am. Soc. Nephrol.
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285: F565-F574
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SALOMON, L., DERAY, G., JAUDON, M. C., CHEBASSIER, C., BOSSI, P., LAUNAY-VACHER, V., DIQUET, B., CEZA, J. M., LEVU, S., BRUCKER, G., RAVAUD, P.
(2003). Medication misuse in hospitalized patients with renal impairment. Int J Qual Health Care
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Park, K. M., Byun, J.-Y., Kramers, C., Kim, J. I., Huang, P. L., Bonventre, J. V.
(2003). Inducible Nitric-oxide Synthase Is an Important Contributor to Prolonged Protective Effects of Ischemic Preconditioning in the Mouse Kidney. J. Biol. Chem.
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de Vries, B., Matthijsen, R. A., van Bijnen, A. A. J. H. M., Wolfs, T. G. A. M., Buurman, W. A.
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Bonventre, J. V.
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Provenchere, S., Plantefeve, G., Hufnagel, G., Vicaut, E., de Vaumas, C., Lecharny, J.-B., Depoix, J.-P., Vrtovsnik, F., Desmonts, J.-M., Philip, I.
(2003). Renal Dysfunction After Cardiac Surgery with Normothermic Cardiopulmonary Bypass: Incidence, Risk Factors, and Effect on Clinical Outcome. Anesth. Analg.
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Padanilam, B. J.
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284: F608-F627
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de Vries, B., Kohl, J., Leclercq, W. K. G., Wolfs, T. G. A. M., van Bijnen, A. A. J. H. M., Heeringa, P., Buurman, W. A.
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Unnikrishnan, D., Lanewala, A., Krishnan, S.
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Thurman, J. M., Ljubanovic, D., Edelstein, C. L., Gilkeson, G. S., Holers, V. M.
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