New approaches to the treatment of acute renal failure

At present, the clinician is left in a relatively dependent position when encountering a patient with established acute renal failure (ARF). Clearly, interventional therapies that can significantly influence the process of recovery from ARF are limited. Although a variety of manipulations and drugs will protect against the loss of renal function when administered prior to the initiation of a renal insult, the clinician usually encounters a patient after ARF has been established. Thus, perturbations that will protect against the development of ARF or modify the severity of the renal insult are not applicable. Moreover, it is clear that the mortality and morbidity for patients with ARF is unacceptably high. Although a variety of supportive measures such as peritoneal/hemodialysis or continuous arteriovenous hemofiltration are now applicable to patients of almost any size or weight, patients continue to die with but perhaps not of ARF. This article will review several new agents that act to enhance the restoration of renal function and result in accelerated recovery of both glomerular and tubular function, following an established acute renal insult: adenine nucleotides, thyroxin, and calcium channel blockers.