Acute renal failure often is preventable. Risk factors for this condition include diabetes mellitus, chronic renal insufficiency, heart failure, and advanced age.
Many medications can injure the kidneys. Dosing schedules can help prevent acute renal failure. For example, acute renal failure is less likely to develop with a once-daily dose of an aminoglycoside than with multiple daily doses.When acute renal failure is diagnosed, the causes must be identified and treated.Critical measures include maintaining adequate intravascular volume and mean arterial pressure, discontinuing all nephrotoxic drugs, and eliminating exposure to any other nephrotoxins.Electrolyte abnormalities must be corrected, and urine output should be monitored closely.
Hyperkalemia is a common complication of acute renal failure.Potassium levels below 6 mEq per L (6 mmol per L) usually can be managed with dietary restriction and resin binders. Sodium bicarbonate therapy should be reserved for the treatment of severe metabolic acidosis with or without associated hyperkalemia.When hyperkalemia is severe and unresponsive to treatment, kidney replacement therapy may be indicated.


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