Acute Renal Failure in the Critically Ill

Over the last 10 years the syndrome of severe acute renal failure has progressively changed in its epidemiology. It is now most frequently seen in critically ill patients, typically in the context of sepsis and multiorgan failure. This epidemiologic change has meant that intensive care physicians and nephrologists must now work in close cooperation at all times and must take many com­ plex issues of prevention, pathogenesis, and management into account that they did not previously have to tackle. Simultaneously, the last 10 years have seen the development of major technical and conceptual changes in the field of renal replacement therapy. There are now previously unavailable therapeutic options that provide physicians with a flexible and rapidly evolving armamentarium. The nutrition of these patients, previously limited by the par­ tial efficacy of renal replacement therapies, has also become more aggressive and more in tune with the needs of critically ill patients. Increased understanding of the pathogenesis of the multi­ organ failure syndrome has focused on the role of many soluble "mediators of injury" (cytokines, leukotrienes, prostanoids etc.). These molecules are likely to participate in the pathogenesis of acute renal failure. Their generation and disposal is also affected by different techniques of artificial renal support.

Pathology of Acute Renal Failure.- Experimental Acute Renal Failure.- Pathophysiology of Acute Renal Failure.- Mechanisms of Tissue Damage in Acute Renal Failure.- Renal Epithelial Repair After Acute Tubular Necrosis.- Prevention of Acute Renal Failure in the Critically Ill Patient.- Epidemiology of Acute Renal Failure.- Measurement of Glomerular Filtration Rate in the Acutely Ill Patient: The Challenge to the Nephrologist in the Intensive Care Unit.- Rhabdomyolysis and Acute Renal Failure.- Drug-Induced Acute Renal Failure.- Hepatorenal Syndrome — Current Concepts of Pathophysiology and Therapy.- Acute Renal Failure in the Neonate: Treatment by Continuous Renal Replacement Therapy.- Conventional Hemodialysis for Acute Renal Failure.- Continuous Hemofiltration in Acute Renal Failure.- Blood Purification by Hemofiltration in Septic Shock and Multiple Organ Dysfunction Syndrome Patients.- Nutrition in Acute Renal Failure.- Immunology of Acute Renal Failure in the Critically Ill.- Adequacy of Renal Replacement Therapy.- Acute Renal Failure in the Intensive Care Unit: Which Treatment Is Best?.- Drug Use in Critically Ill Patients with Acute Renal Failure.