Risk factors for acute renal failure: inherent and... : Current Opinion in Critical Care (original) (raw)

Renal system

Leblanc, Martinea; Kellum, John Ab; Gibney, R T. Noelc; Lieberthal, Wilfredd; Tumlin, Jamese; Mehta, Ravindraf

aDepartments of Nephrology and Critical Care, University of Montreal, Montreal, Canada; bDepartment of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; cDivision of Critical Care Medicine, University of Alberta, Alberta, Canada; dAmgen Inc., Thousand Oaks, California; eDivision of Nephrology, Emory University, Atlanta, Georgia, USA; fDivision of Nephrology, University of California at San Diego, San Diego, California, USA

Correspondence to Martine Leblanc, MD, FRCPc, Nephrology and Critical Care, Maisonneuve-Rosemont Hospital, 5415 de l'Assomption Montreal, QC, Canada, H1T 2M4

Tel: 514 252 3400 ext. 3733; e-mail: [email protected]

Abstract

Purpose of review

Our purpose is to discuss established risk factors in the development of acute renal failure and briefly overview clinical markers and preventive measures.

Recent findings

Findings from the literature support the role of older age, diabetes, underlying renal insufficiency, and heart failure as predisposing factors for acute renal failure. Diabetics with baseline renal insufficiency represent the highest risk subgroup. An association between sepsis, hypovolemia, and acute renal failure is clear. Liver failure, rhabdomyolysis, and open-heart surgery (especially valve replacement) are clinical conditions potentially leading to acute renal failure. Increasing evidence shows that intraabdominal hypertension may contribute to the development of acute renal failure. Radiocontrast and antimicrobial agents are the most common causes of nephrotoxic acute renal failure. In terms of prevention, avoiding nephrotoxins when possible is certainly desirable; fluid therapy is an effective prevention measure in certain clinical circumstances. Supporting cardiac output, mean arterial pressure, and renal perfusion pressure are indicated to reduce the risk for acute renal failure. Nonionic, isoosmolar intravenous contrast should be used in high-risk patients. Although urine output and serum creatinine lack sensitivity and specificity in acute renal failure, they remain the most used parameters in clinical practice.

Summary

There are identified risk factors of acute renal failure. Because acute renal failure is associated with a worsening outcome, particularly if occurring in critical illness and if severe enough to require renal replacement therapy, preventive measures should be part of appropriate management.