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Cellular changes in acute renal failure: functional and therapeutic consequences
M Hohenfellner1, J W Thüroff, K Thurau
1Department of Urology, Klinikum Barmen, Wuppertal, FRG.
Abstract:
Prerenal, renal and postrenal forms of acute renal failure (ARF) are distinguishable. Prerenal forms are reversible by effective treatment of the underlying extrarenal disorder(s). Damage of the endothelium and the tubular epithelium indicates progress of prerenal to renal ARF or induction of primary renal ARF. A continuous survey of renal function based on the cellular and functional pathophysiologic pathways of ARF allows adequate and specific therapy. As both extra- and intrarenal causes of ARF may occur simultaneously under clinical conditions, a broad therapeutic approach should be used: treatment of the extrarenal disorder augmented by measures to reduce the cellular workload, cell-protective therapy, support of microcirculation rheology, and inhibition of prerenal vasoconstriction.
Insights
Acute renal failure (ARF) has distinct forms: prerenal, renal, and postrenal. Effective treatment of prerenal ARF involves addressing underlying causes and employing cell-protective strategies for optimal renal function.
Area of Science:
- Nephrology
- Pathophysiology
- Internal Medicine
Background:
- Acute renal failure (ARF) presents with distinct prerenal, renal, and postrenal forms.
- Prerenal ARF is often reversible with timely treatment of extrarenal conditions.
- Endothelial and tubular epithelial damage signifies progression to or primary renal ARF.
Purpose of the Study:
- To differentiate between forms of acute renal failure.
- To outline a therapeutic approach for ARF.
- To emphasize continuous renal function monitoring.
Main Methods:
- Distinguishing prerenal, renal, and postrenal ARF.
- Assessing cellular and functional pathophysiologic pathways.
- Implementing a broad therapeutic strategy.
Main Results:
- Prerenal ARF is reversible if underlying disorders are treated effectively.
- Endothelial and tubular damage indicate progression or primary renal ARF.
- Simultaneous extra- and intrarenal causes necessitate a comprehensive treatment plan.
Conclusions:
- Continuous monitoring of renal function is crucial for specific ARF therapy.
- A multifaceted therapeutic approach is required for ARF, combining extrarenal disorder treatment with cell-protective measures.
- Therapeutic strategies include reducing cellular workload, supporting microcirculation, and inhibiting vasoconstriction.