Medical therapy of acute kidney injury.
Pharmacologic interventions for the prevention and therapy of acute kidney injury (AKI) can be roughly divided into 2 main strategies: Optimising renal perfusion and modulation of intrarenal pathophysiological mechanisms, i.e. formation of free oxygen radicals, inflammation, tubular cast formation and renal (tubular) regeneration. Improvement of impaired renal perfusion can be achieved by optimising systemic haemodynamics by volume expansion and the appropriate use of inotropes and/or vasopressors. Up to now prospective randomised controlled trials on selective renal vasodilatation have turned out rather unsuccessful, with the exception of the adenosine antagonist theophylline, in certain indications like drug-induced renal failure or contrast nephropathy. Studies in humans on pharmacological interventions interfering with intrarenal pathophysiological mechanisms of AKI are also sparse. Investigated compounds comprise N-acetyl-cysteine, mannitol and antioxidants like selenium or vitamin C. The results are heterogeneous and a significant beneficial effect of either substance could not yet be convincingly demonstrated.
Joannidis
M
M
Medical Intensive Care Unit, Department of General Internal Medicine, Medical University Innsbruck, Austria. Michael.Joannidis@i-med.ac.at
D058186:Acute Kidney Injury / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D000975:Antioxidants / Q000627:therapeutic use; D003287:Contrast Media / Q000009:adverse effects; D004232:Diuretics / Q000627:therapeutic use; D004234:Diuretics, Osmotic / Q000627:therapeutic use; D004921:Erythropoietin / Q000627:therapeutic use; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced / Q000188:drug therapy; D008353:Mannitol / Q000627:therapeutic use; D015337:Multicenter Studies as Topic; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D017382:Reactive Oxygen Species; D012038:Regeneration / Q000502:physiology; D012079:Renal Circulation; D013806:Theophylline / Q000627:therapeutic use; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use
D000975:Antioxidants; D003287:Contrast Media; D004232:Diuretics; D004234:Diuretics, Osmotic; D017382:Reactive Oxygen Species; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D004921:Erythropoietin; D008353:Mannitol; D013806:Theophylline