RT Book, Section
A1 Reddy, Bharathi
A1 Murray, Patrick
A2 Hall, Jesse B.
A2 Schmidt, Gregory A.
A2 Wood, Lawrence D.H.
SR Print(0)
ID 2294512
T1 Chapter 75. Acute Renal Failure
T2 Principles of Critical Care, 3e
YR 2005
FD 2005
PB The McGraw-Hill Companies
PP New York, NY
SN 9780071416405
LK accessanesthesiology.mhmedical.com/content.aspx?aid=2294512
RD 2023/02/05
AB Prerenal  azotemia  and  acute  tubular  necrosis  account  for  the  overwhelming  majority  of  hospital-acquired  acute  renal  failure  cases,  whereas  acute  glomerulonephritis  and  vasculitides  are  more  common  causes  of  acute  renal  failure  developing  outside  the  hospital.Acute  renal  failure  occurs  in  at  least  10%  to  30%  of  patients  admitted  to  an  ICU  and  is  associated  with  a  mortality  rate  of  about  50%  despite  advances  in  supportive  care  and  technology.The  most  important  diagnostic  classification  to  be  made  in  the  evaluation  of  patients  with  acute  renal  failure  is  based  on  the  site  of  the  renal  lesion  (pre-,  intra-,  or  postrenal).Since  there  are  few  specific  therapies  available  in  patients  with  established  acute  tubular  necrosis,  the  major  clinical  focus  is  on  prevention  of  ARF  by  identification  of  subjects  at  highest  risk.All  aspects  of  treatment  of  acute  tubular  necrosis,  including  renal  replacement  therapy,  are  basically  supportive.  The  nondialytic  measures  of  greatest  importance  are  maintenance  of  nutritional,  volume,  and  electrolyte  homeostasis.Emergent  renal  replacement  therapy  is  indicated  in  the  management  of  acute  renal  failure  when  pulmonary  edema,  hyperkalemia,  refractory  acidosis,  or  symptomatic  uremia  develops.Prophylactic  renal  replacement  therapy  should  be  considered  in  patients  with  sustained  anuria,  persistent  oliguria  with  progressive  azotemia  and  glomerular  filtration  rate  <10  mL/  min,  and  to  prevent  uncontrolled  positive  fluid  balance.