Prevention and attenuation of acute renal failure

Recent progress in our understanding of the pathogenetic processes involved in ischemic acute renal failure is considerable. Blockade of the production of endothelium-derived relaxing factor may markedly improve survival in patients with septic shock. Atrial natriuretic peptide and growth factors enhance renal recovery in animal models of acute renal failure, even when administered well after the ischemic insult. Aminoglycosides and radiocontrast agents are the most common causes of drug-induced acute renal failure. Once-daily administration of aminoglycosides is an effective treatment modality that may limit the occurrence of nephrotoxicity. Awareness of the patient's volume status has decreased the incidence of radiocontrast-induced acute renal failure. The new, expensive, nonionic, low-osmolar radiocontrast agents do not offer apparent benefits in patients with normal or slightly decreased renal function. However, use of such agents may decrease the incidence of radiocontrast-induced renal failure in diabetic patients with severe renal failure. The prognosis for patients with renal vasculitis has improved greatly in the past decade. The discovery of antibodies directed against antigenic targets in the cytoplasm of neutrophils has facilitated the diagnosis of renal vasculitides, has improved our knowledge of the pathogenesis of these diseases, and may guide rational treatment.