Therapeutic strategies in the prevention of acute renal failure

The current management of acute renal failure rests largely on the avoidance of ischemic and nephrotoxic insults, attention to fluid and electrolyte balance, and the use of dialytic procedures when necessary. The efficacy of several strategies in experimental renal disease, reviewed in this article, raises the possibility that available to the clinician in the not-too-distant future would be analogous interventions that interrupt pathways of tissue injury and/or summon processes that attenuate the damaging effect of a given insult. The implementation of such therapeutic modalities would expand the management of acute renal failure from its current conservative approach to one encompassing therapeutic interventions that potentially prevent the occurrence of acute renal failure. Moreover, the remarkable and ever-increasing understanding of acute renal failure, in all its deranged cell biology and complex pathogenesis, offers the promise of discerning still better and more effective therapeutic interventions.