ACUTE RENAL FAILURE 吳志仁 醫師 馬偕醫院 腎臟內科

Definition An increase Cr. ≧ 0.5 mg/dl per day An increase of more than 50 % over baseline Cr. A reduction in calculated CCr of 50% Decrease in renal function that results in the need for dialysis

Main Categories of ARF

Acute Tubular Necrosis ARF is not result of primary vascular, glomerular, or interstitial disorder has to been referred to as ATN. Neither the incidence nor the mortality and morbidity rates with ATN decreased, despite ongoing improvement of supportive Rx and renal replacement therapy.

Pathophysiology of Ischemic Acute Renal Failure Vascular Factors Medullary Hypoxia Tubular - Cell Injury Neutrophils and Reperfusion Injury Role of Growth Factors in Recovery from Ischemic ARF

Vascular Factors and Therapy with Vsodilators Dopamine Calcium-Channel Blockers Atrial Natriuretic Peptides PGE 1 Endothelin receptor antagonist Adenosine antagonist Nitric Oxide

Lassnigg A et al, J Am Soc Nephrol 11, ~2 mg/kg/min -- so call renal dose dopamine In double blind, randomized, controlled studies showed no clear experimental or clinical support for renal protective effect of dopamine. There are potential risks associated with even low dose dopamine. These include tachycardia, cardiac arrhythmias, AMI and ischemic bowel. Renal protection effect of dopamine ?

Osmotic Agents and Diuretics Loop diuretics can only increase urine output for fluid management. There is little evidence that conversion from an oliguric to a nonoliguric state decreases the mortality rate.

Tepel M et al, NEJM 2000 Prevention of radiographic contrast agent induced reductionin renal function by ACETYLCYSTEINE

Conclusions The clinical Rx of ARF is still largely supportive. Basic research has provided many, albeit still unproved, approaches to future therapies. Additional experimental models better reflect the multifactorial causes of clinical ARF. Single-drug will probably never be effective, and multiple agents may be need to improve outcome.