Acute renal failure: definitions, diagnosis, pathogenesis, and therapy

Abstract

Acute renal failure (ARF), characterized by sudden loss of the ability of the kidneys to excrete wastes, concentrate urine, conserve electrolytes, and maintain fluid balance, is a frequent clinical problem, particularly in the intensive care unit, where it is associated with a mortality of between 50% and 80%.In this review, the epidemiology and pathophysiology of ARF are discussed, including the vascular, tubular, and inflammatory perturbations.The clinical evaluation of ARF and implications for potential future therapies to decrease the high mortality are described.The Science in medicine series is supported in part by a generous grant from the Doris Duke Charitable Foundation.Nonstandard abbreviations used: acute renal failure (ARF); acute tubular necrosis (ATN); blood urea nitrogen (BUN); continuous renal replacement therapy (CRRT); fractional excretion of filtered sodium (FENa); glomerular filtration rate (GFR); intermittent hemodialysis (IHD); lactic dehydrogenase (LDH); α-melanocyte-stimulating hormone (αMSH); NO synthase (NOS); Tamm-Horsfall protein (THP). Conflict of interest:The authors have declared that no conflict of interest exists.