Renal failure, acute ischemic

Ischemic acute renal failure (ARF), characterized by a sharp decline of glomerular filtration rate, is a very common complication in hospitalized patients and particularly in patients with multiorgan failure. Although it develops most frequently in multimorbid patients, its occurrence per se increases the risk of death by 10- to 15-fold (Ghertow et al, 1998). This unacceptable situation in both diseases warrants the urgent development of new treatment modalities. 

Togel, F., Hn, Z., Weiss, K., Isaac, J., Lange, C. and Westenfelder, C. (2005) Administered mesenchymal stem cells protect against ischemic acute renal failure through differentiation independent mechanisms. Am J Physiol Renal Physiol. 289, F31-42. 

It remains to be clarified why patients with renal hypouricemia frequently develop acute renal failure. The following hypothesis has been proposed. Oxidative stress is essential for the onset of ischemic acute renal failure. In the kidney, uric acid acts as a protective mechanism against oxidative stress. However, in patients with renal hypouricemia, a decrease in uric acid may allow exposure of the kidney to oxidative stress, causing ALPE [152,153]. 

Paller MS, Hoidal JR, Ferris TF (1984) Oxygen free radicals in ischemic acute renal failure in the rat. J Clin Invest 74 1156-1164... 

Figure 2. Phases of Ischemic acute renal failure. A, B, and C refer to therapies aimed at preventing (A) limiting the extension phase (B) and treating established AKI (C). Adapted with permission from [118],...

Molitoris B.Transitioning to therapy in ischemic acute renal failure. J Am Soc. Nephrol. 2003 14 265-267 US Renal Data System, USRDS 2006 Annual Data Report Atlas of end-stage renal disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda MD, 2006. 

Melnikov VY, EcderT, Fantuzzi G, et al. Impaired IL-18 processing protects caspase-1-deficient mice from ischemic acute renal failure. J Clin Invest 2001 107 1145-1152. 

Megyesi J, Andrade L, Vieira J, Safirstein RL, Price PM. Positive effect of the induction of p21 WAFl /CIPl on the course of ischemic acute renal failure. Kidney Int 2001 60 2164-2172. 

Conger JD, Robinette JB, Hammond WS Differences in vascular reactivity in models of ischemic acute renal failure. Kidney Int. 39 1087-1097,1991... 

Mails CD, Cheung JY, Leaf A, Bonventre JV Effects of verapamil in models of ischemic acute renal failure in the rat. Am.J.Physiol. 245 F735-F742,1983... 

Burke TJ, Arnold PE, Gordon JA, Bulger RE, Dobyan DC, Schrier RW Protective effect of intrarenal calcium membrane blockers before or after renal ischemia. Functional, morphological, and mitochondrial studies. J Clin Invest 74 1830-1841,1984 Fried TA, Hishida A, Barnes JL, Stein JH Ischemic acute renal failure in the rat protective effect of uninephrectomy. Am.J.Physiol 247 F568-F574,1984... 

Molitoris BA New insights into the cell biology of ischemic acute renal failure. J Am Soc Nephrol 1 1263-1270,1991... 

Bonventre JV, Zuk A Ischemic acute renal failure an inflammatory disease Kidney Int. 66 480-485,2004... 

Burne MJ, Daniels F, El Ghandour A, Mauiyyedi S, Colvin RB, O Donnell MP, Rabb FI Identification of the CD4(-i-)T cell as a major pathogenic factor in ischemic acute renal failure. J Clin.Invest 108 1283-1290, 2001... 

Safirstein R Gene expression in nephrotoxic and ischemic acute renal failure [editorial]. J Am Soc Nephrol. 4 1387-1395,1994 MegyesI J, Dl Marl J, Udvarhelyl N, Price PM, Safirstein R DNA synthesis is dissociated from the immediate-early gene response In the post-lschemic kidney. Kidney Int 48 1451-1458,1995... 

Kielar ML, John R, Bennet M, Richardson JA, Shelton JM, Chen L, Jeyarajah DR, Zhou XJ, Zhou H, Chiquett B, Nagami GT, Lu CY Maladaptive role of IL-6 in ischemic acute renal failure. J.Am.Soc.Nephrol. 16 3315-3325,2006... 

Thurman JM, Ejubanovic D, Edelstein CL, Gilkeson GS, Holers VM Lackof a functional alternative complement pathway ameliorates ischemic acute renal failure in mice. Journal of Immunology 170 1517-1523,2003... 

R.Takeda, H. Nishimatsu, E. Suzuki, H. Satonaka, D. Nagata, S. Oba, et al. Ghrelin improves renal function in mice with ischemic acute renal failure. J Am Soc Nephrol 2006 17(1 ) 113-21. 

Kakoki M, Hirata Y, Hayakawa H, Suzuki E, Nagata D,Tojo A, Nishimatsu H, Nakanishi N, Hattori Y, Kikuchi K, NaganoT, Omata M Effects of tetrahydrobiopterin on endothelial dysfunction in rats with ischemic acute renal failure. J Am Soc Nephrol 11 301 -9,... 

Forbes JM, HewitsonTD, Becker GJ, Jones CL Ischemic acute renal failure long-term histology of cell and matrix changes in the rat. Kidney Int 57 2375-85, 2000... 

Chan L, Chittinandana A, Shapiro Jl, Shanley PF, Schrier RW Effect of endothelin-receptor antagonist on ischemic acute renal failure. Am.J.Physiol. 266 F135-F138,1994... 

Lin JJ, Churchill PC, Bidani AK. Theophylline in rats during maintenance phase of post-ischemic acute renal failure. Kidney Int 1988 33 24-28. 

Renal failure was studied by Cochrane et al. [116]. They used ischemic preconditioning to attenuate functional, metabolic, and morphologic injury from ischemic acute renal failure in rats. The value of preconditioning was studied in particular. 

J. Cochrane, B. T. Williams, A. Banerjee, A. H. Harken, T. J. Burle, C. B. Cairns, and J. I. Shapiro, Ischemic Preconditioning Attenuates Functional, Metabolic, and Morphologic Injury from Ischemic Acute Renal Failure in the Rat, Renal Failure, 21(2), 135-145 (1999). 

Figure 45-1 i Pathogenesis of ischemic acute renal failure. Hypoxic insults cause vascular responses and tubular damage. (From Bonventre Weinberg JM. Recent advances in the pathophysiology of ischemic acute renal failure. J Am Soc Nephrol 2003 14 2199-210.)... 

Sutton TA, Fisher CJ, Molitoris BA. Microvascular endothelial injury and dysfunction during ischemic acute renal failure. Kidney Int 2002 62 1539-1549. 

Nephrotoxins or ischemic disorders can initiate acute renal failure. Shock, hemorrhage, septicemia, or vasodilation due to hypertensive medication can precipitate ischemic acute renal failure. Systemic reactions to certain drugs and nephrotoxins such as aminoglycoside antibiotics and heavy metals lead to acute renal failure. The extent of retention of creatinine and urea in blood is directly related to the severity of acute renal failure. This condition is not readily reversible and, as such, should be distinguished from reversible phenomena such as prerenal or postrenal azotemia, in which there is also an increase in levels of plasma urea and creatinine (13). In volume-depleted states, for example, diarrhea, the kidney is hypoprefused. This results in increased back diffusion of urea into the circulation from the tubular fluid because of the reduced urine flow. In addition to an increase in urea levels in circulation, there is also a slow increase in creatinine levels. Plasma urea and creatinine levels can be restored to normal within 24 hours by appropriate fluid and electrolyte replacement in prerenal azotemia. In condi-... 

There are also gender differences in susceptibUity to ischemic acute renal failure in mice. Male mice may be more susceptible to renal ischemia than females [17]. 

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