Acute renal failure: Overview of current and potential therapies

Although numerous therapies have been used for the treatment and prevention of acute renal failure (ARF), none has been successful in reducing mortality. Agents commonly used in the management of ARF include mann tol, loop and thiazide diuretics, and dopamine. Mannitol has a role for oliguric patier ts with ARF, but its usefulness for anur c patients is limited. While loop diuretics effectively convert patients to nonoliguria, they fail to consistently reduce dialysis requirements and have no effect on morality. Thiazide diuretics may be useful as in adjunct to loop diuretics if the patient's diuretic response is not maintained. Although dopamine increases urine output, it has not demonstrated an effect on biochemical markers or dialysis requirements. Given the many potential complications associated with dopamine, patients may be more appropriately managed with diuretics alone. Among the agents being investigated for prevention or treatment of ARF are atrial natriuretic peptide, calcium channel blockers, and fenoldopam. While these potential therapies have shown promise for select applications or patient populations, further controlled trials are needed before their routine use can be recommended.

Duke Scholars

Author Jennifer H. Saullo Medicine, Infectious Diseases