[Acute renal failure following surgical insult]

It has been claimed that acute renal failure (ARF) following surgical insult was mainly due to the reduction in renal blood flow, especially in renal cortical blood flow. Recent studies, however, pointed out that the majority of the surgical ARF developed due to prolonged SIRS (systemic inflammatory response syndrome) and that those patients developed ARF as a part of multiple organ failure (MOF) complicating other organ failures such as acute respiratory failure. It has been also pointed out that variety of humoral mediators including pro-inflammatory cytokines play a major role in the development of ARF following SIRS. Therefore, the management of such ARF should include some countermeasures against humoral mediators. Various blood purifications have been applied in the management of the patients with ARF. Recently continuous blood purifications got their popularity in the management of the critically ill. Continuous hemodiafiltration (CHDF) has been reported to be applied without any hazardous side effect on the most critically ill patients. CHDF can not only support failing renal function but also can effectively remove causative humoral mediators from the blood stream of the patients. Therefore the CHDF is the first choice blood purification in the management of the ARF patients following surgical insults.