Kunzendorf, Ulrich (2009) Pharmacologic Therapies for Acute Renal Failure. Basic & clinical pharmacology & toxicology, 105 (Suppl. S1). p. 15. DOI 10.2165/11535890-000000000-00000.

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Abstract

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
Keywords:	Renal Replacement Therapy, Acute Kidney Injury, Atrial Natriuretic Peptide, Terlipressin Ethyl Pyruvate
Research affiliation:	Kiel University Kiel University > Kiel Marine Science OceanRep > The Future Ocean - Cluster of Excellence
Refereed:	Yes
Open Access Journal?:	No
Publisher:	Springer
Projects:	Future Ocean
Date Deposited:	11 Feb 2011 12:14
Last Modified:	23 Sep 2019 21:20
URI:	https://oceanrep.geomar.de/id/eprint/9536

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