ABSTRACT
The goal of this chapter is to provide information that will assist intensive care unit staff in the management of patients with acute renal failure (ARF). Acute intrinsic renal failure is commonly associated with ischemic events or exposure to nephrotoxins, although it may be caused by other mechanisms including renal infections, immune mediated diseases, and hypercalcemia. A common event in both ischemic and nephrotoxic ARF is structural and functional damage to renal tubules, giving rise to the term “acute tubular necrosis.” Conceptually the syndrome of ARF may be divided into three sequential stages: initiation, maintenance, and recovery. There are many similarities between the clinical manifestations of acute and chronic renal failure. The kidneys’ capacity to produce urine is best assessed in well-hydrated patients with adequate blood pressure. Early recognition of acute renal failure is important since therapeutic intervention during the induction stage is most likely to be successful in minimizing renal injury.
