Cellular changes in acute renal failure: functional and therapeutic consequences.

Abstract

Prerenal, renal and postrenal forms of acute renal failure (ARF) are distinguishable. Prerenal forms are reversible by effective treatment of the underlying extrarenal disorder(s). Damage of the endothelium and the tubular epithelium indicates progress of prerenal to renal ARF or induction of primary renal ARF. A continuous survey of renal function based on the cellular and functional pathophysiologic pathways of ARF allows adequate and specific therapy. As both extra- and intrarenal causes of ARF may occur simultaneously under clinical conditions, a broad therapeutic approach should be used: treatment of the extrarenal disorder augmented by measures to reduce the cellular workload, cell-protective therapy, support of microcirculation rheology, and inhibition of prerenal vasoconstriction.