Definition n An increase Cr 0 5 mgdl

Acute Tubular Necrosis n ARF is not result of primary vascular, glomerular, or interstitial

Pathophysiology of Ischemic Acute Renal Failure n Vascular Factors n Medullary Hypoxia n Tubular

Vascular Factors and Therapy with Vsodilators n Dopamine n Endothelin n Calcium-Channel receptor antagonist

Renal protection effect of dopamine ? n 0. 5~2 mg/kg/min -- so call renal

Osmotic Agents and Diuretics n Loop diuretics can only increase urine output for fluid

Prevention of radiographic contrast agent induced reductionin renal function by ACETYLCYSTEINE Tepel M et

Conclusions n The clinical Rx of ARF is still largely supportive. n Basic research

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Definition n An increase Cr. ≧ 0. 5 mg/dl per day n An increase of more than 50 % over baseline Cr. n A reduction in calculated CCr of 50% n Decrease in renal function that results in the need for dialysis

Main Categories of ARF

Acute Tubular Necrosis n ARF is not result of primary vascular, glomerular, or interstitial disorder has to been referred to as ATN. n Neither the incidence nor the mortality and morbidity rates with ATN decreased, despite ongoing improvement of supportive Rx and renal replacement therapy.

Pathophysiology of Ischemic Acute Renal Failure n Vascular Factors n Medullary Hypoxia n Tubular - Cell Injury n Neutrophils and Reperfusion Injury n Role of Growth Factors in Recovery from Ischemic ARF

Vascular Factors and Therapy with Vsodilators n Dopamine n Endothelin n Calcium-Channel receptor antagonist n Adenosine antagonist n Nitric Oxide Blockers n Atrial Natriuretic Peptides n PGE 1

Renal protection effect of dopamine ? n 0. 5~2 mg/kg/min -- so call renal dose dopamine n In double blind, randomized, controlled studies showed no clear experimental or clinical support for renal protective effect of dopamine. n There are potential risks associated with even low dose dopamine. These include tachycardia, cardiac arrhythmias, AMI and ischemic bowel. Lassnigg A et al, J Am Soc Nephrol 11, 2000

Osmotic Agents and Diuretics n Loop diuretics can only increase urine output for fluid management. n There is little evidence that conversion from an oliguric to a nonoliguric state decreases the mortality rate.

Prevention of radiographic contrast agent induced reductionin renal function by ACETYLCYSTEINE Tepel M et al, NEJM 2000

Conclusions n The clinical Rx of ARF is still largely supportive. n Basic research has provided many, albeit still unproved, approaches to future therapies. n Additional experimental models better reflect the multifactorial causes of clinical ARF. n Single-drug will probably never be effective, and multiple agents may be need to improve outcome.