Management of Acute Renal Failure

Management of Acute Renal Failure

• There are no specific treatment modalities for ARF; management is essentially supportive and aimed at limiting further renal injury and correcting the water, electrolyte, and acid-base derangements.
• Underlying causes should be sought and terminated or reversed, if possible; specifically, hypovolemia, hypotension, and low cardiac output should be corrected and sepsis eliminated. A minimal mean arterial pressure of 65 mm Hg should be attained.
• Fluid resuscitation and the use of vasopressor therapy are universally emphasized in the prevention and treatment of ARF.
• After fluid resuscitation try furosemide 240 mg over 1 hour
• Avoid all non-essential nephrotoxic drugs
• Adjust doses of renally excreted drugs
• Measure sodium, potassium, bicarbonate and urea and/or creatinine twice daily
• The principles guiding the management of anesthesia are the same as those that guide supportive treatment of ARF, namely, maintenance of an adequate mean systemic blood pressure and cardiac output and the avoidance of further renal insults including hypotension, hypovolemia, hypoxia, and nephrotoxic exposure.