Drugs for the prevention and treatment of acute renal failure
Donald G. Vidt, MD
Frank Cosentino, DOAddress reprint requests to F.C., Department of Nephrology and Hypertension, A101, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
Certain preventive measures might decrease the incidence or severity of acute renal failure, including vigorous hydration before the administration of radiocontrast agents, and use of mannitol, loop diuretics, dopamine, and calcium antagonists. However, the pharmacologic agents should be used judiciously, and clinicians should not accept blindly that they are indicated in all clinical situations involving acute renal failure until further studies are available.KEY POINTS
Mannitol, loop diuretics, dopamine, and calcium antagonists show promise in most experimental animal studies, although their effects depend on the type of experimental model studied.
These agents have found wide acceptance in clinical practice, even though their efficacy has not been adequately demonstrated in prospective, randomized clinical trials involving adequate sample sizes.
As we learn more about the pathophysiology of ischemic and toxic acute renal failure, we will be able to selectively use these medications in a more rational fashion, minimize their unnecessary use, and reduce their potential for adverse effects.