Acute renal failure: prevention and nondialytic therapy

Acute renal failure (ARF) is a common illness with significant associated mortality and morbidity. Despite the advent of renal replacement therapy and the advancement in dialytic technology, the mortality of ARF has not significantly changed in the last 30 years. The cost of treating acute renal failure with the available therapies inflicts a tremendous financial burden on the health care system. The majority of patients with acute renal failure have multiple etiologies which are frequently iatrogenic. Physicians frequently underestimate the level of renal dysfunction in patients and therefore interventions to curb or treat renal failure are delayed. It is clear that ARF can be averted with more vigilance and early interventions. No pharmacological agent has yet been approved for the treatment of acute renal failure. Several substances are in the various stages of animal and human trials. Until one becomes available for use in the treatment of renal failure, it is clear that prevention is the principal element in the management of ARF. The purpose of this review is to discuss the various risk factors for acute renal failure, methods of prevention, and pharmacological interventions that may be beneficial in the treatment of ARF.