Renal failure, acute management

Loop diuretics are the diuretics of choice for the management of volume overload in acute renal failure. 

Continuous renal replacement therapy is used for the management of fluid overload and removal of uremic toxins in patients with acute renal failure and other conditions. Drug therapy individualization for patients receiving continuous renal replacement therapy is discussed in Chap. 75. 

Bagshaw SM, Delaney A, Haase M, Ghali WA, Bel-lomo R. Loop diuretics in the management of acute renal failure a systematic review and meta-analysis. Crit Care Resusc 2007 9 60-8. 

Slack A, Ho S, Forni LG (2007) The management of acute renal failure. Medicine 35 434—437. 

Ronco C, Zanella M, Brendolan A, Milan M, Canato G, Zamperetti N, Bellomo R. Management of severe acute renal failure in critically ill patients an international survey in 345 centres. Nephrol Dial Transplant 2001 16(2) 230-237. 

Cole L, Bellomo R, Silvester W, Reeves JFI. A prospective, multicenter study of the epidemiology, management, and outcome of severe acute renal failure in a "closed" ICU system. Am J Respir Crit Care Med 2000 162 191-196... 

Kasiske BL, Kjellstrand CM. Perioperative management of patients with chronic renal failure and postoperative acute renal failure. Urol Clin North Am 1983 10(1) 35-50. 

Better OS. Early management of shock and prophylaxis of acute renal failure in traumatic rhabdomyolysis. N Engl J Med 1990 322 825-828. 

Shilliday I R, Quinn K J, Allison M E 1997 Loop diuretics in the management of acute renal failure a prospective, double-blind, placebo-controlled, randomized study. Nephrology, Dialysis and Transplantation 12 2592-2596... 

Singer I, Epstein M 1998 Potential of dopamine A-1 agonists in the management of acute renal failure. American Journal of Kidney Disease 31 743-755 Spier S J, Carlson G P, Holliday T A et al 1990... 

Stevens PE, Taraimi NA, Al Hasani MK, Mikhail Al, Kearney E, Lapworth R> et al. Non-specialist management of acute renal failure. Q J Med 2001 94 533-40. 

Although the kidneys continually produce urine, the bladder stores the urine for intermittent elimination. For the initial diagnosis and management of acute circulatory insufficiency, a catheter can be inserted into the bladder for measuring urine output. In contrast to thirst, which is a relatively insensitive indicator of volume depletion, urine output is generally diminished with inadequate fluid administration and increases with appropriate resuscitation. This presumes, of course, that acute renal failure or medications such as diuretics are not altering the expected response. Adults should produce at least 0.5 to 1 mL/kg per hour of urine, whereas children up to 12 years of age should produce at least 1 mL/kg per hour (2 mL/kg per hour if younger than 1 year of age). ... 

Major differences exist between the metabolic, fluid, and electrolyte management of patients with acute versus chronic kidney disease (CKD). For example, positive nitrogen balance is more difficult to achieve in patients with acute renal failure (ARF) due to the increased rate of protein catabolism. Additionally, patients with acute renal failure are more likely to develop hyperglycemia during nutritional support and frequently are dialyzed by modalities that are not used commonly for the patient with end-stage kidney disease (ESKD). Because of these differences, the nutritional management of patients with ARF is discussed separately. 

Druml W. Nutritional management of acute renal failure. Am J Kidney Dis 2001 37(1 Suppl 2) S89-S94. 

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