Acute Renal Failure: Drug Therapy

Therapeutic target

  • Improvement of the symptomatology

Therapy recommendations

  • Loop diuretics (drugs for drainage) for overhydration and preserved diuresis (urinary excretion)Note: Therapeutic “flushing” of the kidney with large infusion volumes and administration of loop diuretics is now considered obsolete; it has no effect on acute renal failure.
  • In acute renal failure (ANV), the following measures should be implemented:
    • Stabilize hemodynamics/blood flow in vessels (volume, norepinephrine in septic shock/shock from sepsis, dobutamine in cardiogenic (“heart-related”) shock, epinephrine in refractory shock), lower blood pressure in hypertensive crisis (blood pressure crisis)Cave! (Caution!) No volume overload; artificial colloids should be avoided.
    • Acid-base balance and electrolytes (blood salts) balance (applies insb. also for the phase after resumption of diuresis).
    • Sonography / ultrasound (urinary retention?)
    • If necessary, eliminate nephrotoxins (“renal toxins”); if necessary, see also under “Intoxications/Medicinal Therapy“; therapy usually consists of supportive and symptomatic, if necessary intensive medical measures.
    • Adjust pharmacotherapy (drug therapy)
    • Avoid negative nitrogen balance. This means that more proteins are broken down by the body in the muscles than built up (catabolic metabolism); this makes enteral nutrition (e.g., by stomach tube) necessary
    • Check indication for hemodialysis (blood washing) or for CVVH (continuous venovenous hemofiltration; 24 h/d blood washing) in timeIndications are:
      • Laboratory parameters: Serum urea level above 200 mg/dl, a serum creatinine level above 10 mg/dl, a serum potassium level above 7 mmol/l, or a bicarbonate concentration below 15 mmol/l.
      • Diuretic-resistant hyperhydration with pulmonary edema/water retention in the lungs, heart failure (cardiac insufficiency), and onset of cerebral edema (brain swelling)
      • Uremia signs such as pericarditis/pericarditis and gastroenteritis (gastrointestinal flu).

      Note: Early initiation of renal replacement therapy (AKIN stage 2: doubling of creatinine) significantly improved patient survival (reduction in mortality at 90 days from 54.7 to 39.3 percent). It should be noted, however, that in this study the patients were predominantly surgical patients and thus the study is not representative of other patient groups.

    • Diuretics (drugs for drainage) do not improve the prognosis of acute renal failure!
  • See also under “Further therapy“.