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.