An evaluation of pharmacological strategies for the prevention and treatment of acute renal failure

Acute renal failure (ARF) occurs frequently in hospitalised patients, and i s associated with significant morbidity and mortality. The most common and generalised forms of acute renal failure are pre-renal conditions and intra -renal acute tubular necrosis (ATN). Pre-renal ARF in its pure state should be entirely reversible by restoring renal perfusion, but in some cases ATN has already occurred. ATN remains a more vexing problem, and is seen mast often with hypotension, perioperative or systemic inflammatory stresses, ra diocontrast administration, and exposure to nephrotoxins. Among the availab le pharmacologic options for prevention or treatment of ATN, there is a rem arkable lack of definitive evidence supporting specific therapy in any sett ing. Although loop diuretics, mannitol, and dopamine are frequently used fo r prevention and/or treatment of ATN, clinical studies have failed to prove value. Other drugs with theoretical value, specifically atrial natriuretic peptide analogues, adenosine blockers, and calcium antagonists, have been insufficiently studied to recommend use. Other pharmacological options may arise in the future. Ensuring adequate intravascular fluid volume remains t he only approach to managing ATN which can be considered relatively effecti ve and safe. Given the abundant theoretical basis far the prevention and tr eatment of ATN with drugs, well conducted clinical studies with relevant ou tcome measures are clearly warranted.