Prevención de la insuficiencia renal aguda en el paciente crítico / Prevention of acute renal failure in critical patient

RESUMO

Chronic renal insufficiency (CRI) is common in chronic patients (6 to 23 percent incidence), with a 50 to 70 percent mortality rate which can reach 100 percent when this involves a multiple more than five organ failure. For practical purposes, CRI is classified into prerenal, renal, and postrenal. Knowledge of physiopathological fundamentals and diagnostic elements allows us to take adequate measures to preserve renal function. This article revises renal function protective measures against the principle causes of CRI in chronic patients: ischemic and toxic CRI, i.e. contrast agents, pigments, anfotericine, and aminoglycosides. in ischemic CRI we analyse the key factors in renal perfusion, highlighting the importance of replenishing extracelular volume, and the benefits of using norepinefrine in septic shock. The renal effect of other vasoactive and inotropic drugs such as epinephrine, dobutamine, milrinone, and dopexamine are revised, highlighting the absence of clinical evidence that supports the use of dopamine as a renal function protector. Renal actions and possible favorable effects of diuretic manitol and furosemide are analysed. In toxic CRI, we analyse the beneficial effect of fluids and the use of specific measures such as alkalinization of urine, the use of acetylcysteine, liposomal anfotericine, and single dose aminoglycosides