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Renal protective agents: a review.

G J Duke1

  • 1Intensive Care Department, The Northern Hospital, Epping, VIC, Australia gduke@tnh.vic.gov.au.

Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine
|April 11, 2006
PubMed
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In critically ill patients, tubular ischemia causes acute kidney injury. While many drugs show promise in animal studies, only volume loading and pressor agents for renal perfusion pressure offer reliable protection in humans.

Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Acute kidney injury (AKI) is a significant complication in critically ill patients.
  • Tubular ischemia is a primary cause of AKI in this population.
  • Many pharmacological agents have been investigated for renal protection.

Purpose of the Study:

  • To review the efficacy of drugs with potential benefits to renal function in critically ill patients.
  • To identify evidence-based strategies for preventing AKI in the intensive care unit.

Main Methods:

  • A comprehensive literature search was conducted using MEDLINE, covering articles published from 1966 to 1998.
  • The search focused on studies related to kidney failure and interventions for renal protection.

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Main Results:

  • While numerous agents demonstrate efficacy in animal models of AKI, robust human data are often lacking.
  • Evidence supports maintaining extracellular volume and renal perfusion pressure, though controlled trials are limited.
  • Controlled trials do not support the routine use of furosemide, dopamine, or mannitol for AKI prevention.
  • Mannitol and calcium channel blockers have limited data for renal transplantation, with unconfirmed benefits in critically ill patients.

Conclusions:

  • Tubular ischemia is the common pathway for renal dysfunction and AKI in critically ill patients.
  • Preventing tubular ischemia is paramount for renal protection.
  • Volume loading and pressor agents to maintain renal perfusion pressure are the most reliable methods for renal protection currently available.