Renal failure, acute prevention

Fleury D,Vanhille P, Pallet IL, Kleinknecht D. Drug induced acute renal failure a preventable disease linked to drug misuse. Kidney Inti 990 38 1238. 

Mannitol (Osmitrol) is used for the promotion of diuresis in the prevention and treatment of the oliguric phase of acute renal failure as well as for the reduction of IOP and the treatment of cerebral edema Urea (Ureaphil) is useful in reducing cerebral edema and in die reduction of IOE Glycerin (Osmoglyn) and isosorbide (Ismotic) are used in the treatment of acute glaucoma and to reduce IOP before and after eye surgery. 

Renal dose dopamine is not recommended in the prevention or treatment of acute renal failure. 

Identifying patients at high risk for development of acute renal failure and implementing preventive methods to decrease its occurrence or severity is critical. 

Venkataraman R. Prevention of acute renal failure. Crit Care Clin 2005 21 281-289. 

Noiri et al. used AS-ODN to inhibit production of inducible nitric oxide synthase (INOS) in an attempt to prevent NO production in an ischaemic kidney. A single intravenous injection of iNOS AS-ODN attenuated acute renal failure and reduced the morphological abnormalities [129],... 

Fujii, T., Takaoka, M., Muraoka, T., Kurata, H., Tsuruoka, N., Ono, H., Kiso, Y., Tanaka, T., and Matsumura, Y. (2003). Preventive effect of L-carnosine on ischemia/reperfusion-induced acute renal failure in rats. Eur.. Pharmacol. 474, 261-267. 

Treatment and prevention of acute hypotension shock (associated with cardiac decompensation, Ml, open heart surgery, renal failure, or trauma), treatment of low cardiac output, treatment of CHF IV 1 mcg/kg/min up to 50 mcg/kg/min titrated to desired response. 

A potential therapeutic approach to protecting or reversing renal GM damage would have very important clinical consequences. GM administration in rats provides an excellent model of acute renal failure for studying therapeutic potential in preventing the side effects of acute renal failure pathogenesis in humans. 

As their name suggests, osmotic diuretics such as mannitol (Osmitrol), isosorbide (Ismotic), and glycerin (Osmoglyn) draw fluid from the tissues of the body through principles of osmosis. Osmotic diuretics are typically given to treat or prevent acute renal failure (kidney failure). They may also be used to relieve intracranial pressure (swelling of the brain) in cases of head injury or hydrocephalus. 

The most common adverse effects are indirect hyperbilirubinemia and nephrolithiasis due to crystallization of the drug. Nephrolithiasis can occur within days after initiating therapy, with an estimated incidence of 3-15%, and may be associated with renal failure. Consumption of at least 48 oz of water daily is important to maintain adequate hydration and prevent nephrolithiasis. Thrombocytopenia, elevations of serum aminotransferase levels, nausea, diarrhea, and irritability have also been reported. There have also been rare cases of acute hemolytic anemia. In rats, high doses of indinavir are associated with development of thyroid adenomas. 

Acute renal failure secondary to ischemia-reperfusion or nephro-toxins represents a major cause of morbidity and mortality in hospitalized patients, particularly in the intensive care unit setting. The proximal tubule region of the nephron suffers the most damage in acute renal injury and is therefore the target site of therapeutic interventions. While several experimental therapies have been attempted to prevent or hasten recovery from acute renal injury,... 

Dai, C., Yang, J. and Liu, Y. (2002). Single injection of naked plasmid encoding hepatocyte growth factor prevents cell death and ameliorates acute renal failure in mice. J. Am. Soc. Nephrol. 13, 411-422. 

Methods of preventing exercise-induced acute renal failure (ALPE) and relapse have not been established as the etiology and pathogenesis of ALPE remain to be clarified. However, the following points are important. 

Yeun JY, Hasbargen JA (1995) Renal hypouricemia prevention of exercise-induced acute renal failure and a review of the literature. Am J Kidney Dis 25 937-946... 

A substantial body of literature documents the side effects of platinum compounds. The nephrotoxicity of the parent compound cisplatin almost led to its abandonment, until Cvitkovic et al. introduced aggressive hydration, which prevented the development of acute renal failure [2] [3], As noted above, the toxicity of cisplatin was a driving force both in the search for less toxic analogues and for more effective treatments for its side effects, especially nausea and vomiting. 

The next day the patient had decreased respiratory rate, became tired with falling blood sugar and acidosis. She had acute renal failure with urine output <30 mL/h and was in fluid overload. The doctors started her on terlipressin 2 mg q.d.s. and HAS (Human Albumin Solution) 20% to maintain central venous pressure 8-12 mmHg and prevent hepatorenal syndrome. Terlipressin is a prodrug for vasopressin. 

The immunosuppressant agents, cyclosporin A (cys A) and FK506 both have the potential to induce acute renal failure and endothelin has been proposed as the mediator. Cys A and FK506 have both been shown to stimulate ET-1 release from cultured kidney cells [200]. An endothelin antibody prevented the reduction in function induced by cys A in a rat kidney perfusion model [201]. In the same model, BQ 123 also prevented the detrimental renal effects of cys A [202]. 

Centers for Disease Control and Prevention (CDC). Acute hepatitis and renal failure following ingestion of raw carp gallbladders—Maryland and Peimsylvania, 1991 and 1994. MMWR Morb Mortal Wkly Rep 1995 44(30) 565-6. 

Dishart MK, Kellum JA. An evaluation of pharmacological strategies for the prevention and treatment of acute renal failure. Drugs 2000 59(1) 79-91. 

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