Prevention of AKI and Protection of the Kidney

Abstract

Simplistically, interventions to protect the kidney against damage may be classified according to two approaches: either optimising renal blood flow to ensure adequate perfusion and oxygen delivery or the modulation of intrarenal pathophysiological mechanisms such as reducing free oxygen radical formation, inflammation, tubular cast formation and tubular regeneration. Improving renal perfusion is achieved through correction of systemic haemodynamics where necessary through volume expansion and the appropriate use of inotropes and vasopressors. Disappointingly, studies using selective renal vasodilators have been unimpressive to-date with the exception of niche areas such as adenosine antagonism by theophylline in patients at risk of contrast nephropathy. Available pharmacological interventions effective in the modulation of intrarenal pathophysiological mechanisms where the kidney is at risk are sparse, again with small studies in niche conditions such as the use of N-acetylcysteine and vitamin C in contrast nephropathy, mannitol in crush injury and selenium in septic acute renal failure.