Prevention of drug-induced nephrotoxicity in the intensive care unit

Acute renal failure (ARF) occurs in 5% to 25% of all admissions to an intensive care unit (ICU). The development of ICU-associated ARF increases the average mortality from about 15% to more than 60%. ARF is also associated with significant prolongation of hospital stay as well as substantial expense. Recent studies suggest that a significant percent of hospital-acquired ARF is caused by nephrotoxins. This brief review will discuss the frequency of occurrence, pathophysiology, risk factors, clinical course, and prevention of nephrotoxicity that may occur after exposure to aminoglycosides, nonsteroidal anti-inflammatory drugs, and radiographic contrast agents.