[Tubulointerstitial damage attributable to acute circulatory failure: postischemic acute renal failure]

Renal damage attributable to acute circulatory failure includes prerenal azotemia, postischemic acute renal failure and bilateral renal cortical necrosis. In this review, recent findings of the pathophysiology, diagnosis, and treatment of postischemic acute renal failure are reviewed. The medullary thick ascending limb of Henle and the proximal straight tubule are extremely susceptible to ischemic damage because of the characteristic anatomical feature of the vasa recta in the medulla. Appropriate supportive treatment and initiation of dialysis early in the course of acute renal failure improve survival. However, the prognosis of acute renal failure with multiple organ failure is poor. Further studies on the precise cellular mechanism of acute renal failure may provide us with some future modes of treatment.