Abstract
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.
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