How to prevent acute renal failure from occurring in your hospital

摘要

Acute renal failure (ARF) results from an abrupt decline in renal function and is usually caused by an ischemic or toxic insult. Unfortunately in many cases, ARF inadvertently develops in the hospital setting in conjunction with diagnostic or therapeutic procedures. For example, ARF may result from decreased renal perfusion associated with anesthesia and surgery or with the use of vasodilators and nonsteroidal antiinflammatory drugs (NSAIDs). Similarly, ARF frequently occurs in patients treated with potential nephrotoxicants like gentamicin, amphotericin, and cisplatin. The nephron damage that occurs with ARF is not always reversible; animals that do recover adequate renal function usually require prolonged and expensive intensive care. Two recentretrospective studies have documented the poor prognosis associated with ARF in dogs. In a study of hospital-acquired ARF, the survival rate was 40 percent, whereas in another study of all types of ARF, the survival rate was 24 percent. (Toxicant and ischemic-induced ARF in people is associated with a mortality rate of 50 to 60 percent, despite the widespread availability of hemodialysis.) Obviously, prevention of hospital-acquired ARF is important. Several risk factors have been identified that predispose dogs to gentamicin-induced ARF (Table), however it is likely that many of these risk factors also predispose dogs and cats to other types of toxicant-induced ARF as well as ARF induced by ischemia. A combination of decreased renal perfusion and/or use of nephrotoxic therapeutic agents superimposed on more chronic, preexisting risk factors is usually responsible for ARF in the clinical setting. Knowledge of these predisposing risk factors allows the clinician to assess the risk-benefit ratio in individual cases in which an elective anesthetic procedure is considered or the use of potentially nephrotoxic drugs is indicated. In some cases, predisposing risk factors can be corrected prior to any potential renal insults.