Management Of Acute Renal Failure Research Articles

Management of acute renal failure in infants: a seven-year multicenter experience.

Background. An infant with acute kidney injury (AKI) represents a technical challenge with respect to vascular access. Acute peritoneal dialysis (PD) is often the only possible treatment modality. Patients and methods. Over a period of 7 years (2014 -2021), the outcome of acute PD was studied in 56 infants (38 boys) with AKI, aged 6 hours to 24 months, at 3 tertiary care centers of a teaching hospital in Algeria. Results. Acute tubular necrosis (58.9%) was the most common cause of AKI, followed by hemolytic uremic syndrome (23.2 %). Acute PD was highly effective in lowering retention markers (p < 0.0001). The reduction of blood urea greater than 11% after 10 cycles of PD would be the first sign of good evolution followed by that of serum creatinine at 10% after 15 cycles (p < 0.0001). Hypokaliemia was the most common complication (46.4%). Overall mortality was 23.2 %. The risk of mortality by multi-variate analysis was higher with the Severity of AKI and when patients were anuric (p < 0.0001), septicemia (p < 0.0001), or decompensated congenital heart disease (p < 0.001) The survivors did not differ from those who died with respect to age, sex or weight when acute PD was initiated. The average time to renal function recovery was between 72 hours and 12 days. Conclusion. Acute PD is an appropriate treatment choice for infants with AKI. The reduction of blood urea after 10 cycles of PD is a good predictor of evolution.

Management of CVVHDF for Acute Renal Failure Patients with Sepsis After Post Exploratory Laparotomy Colonic Resection in Intensive Care Unit: A Case Report

Acute renal failure (ARF) is a condition that may occurs in susceptible postoperative patients. The incidence of ARF reaches 30−60% and it is more after major surgery (e.g., laparotomy, heart surgery). It is often caused by hypovolemia, hypoperfusion, and systemic inflammation. Laparotomy is a major and complex operation that can lead to complications including ARF, acute pulmonary edema, sepsis, and increased morbidity and mortality.
 A 76-year-old female patient underwent exploratory laparotomy for acute abdominal indications with suspected obstructive ileus with sepsis. Postoperatively, the patient was treated in the ICU using a ventilator. On the third day the patient's renal function and urine volume decreased. Creatinine level 5.19 mg/dL, urea 217 mg/dL and urine was 0.2 ml/kg/h. The patient was given diuretics but she did not show clinical and laboratory improvement. We decided to perform hemodialysis with continuous veno-venous hemodiafiltration (CVVHDF) mode because the patient was in septic condition and hemodynamic instability. CVVHDF was performed for three days, periodic laboratory examinations were performed to assess the patient's renal function. After three days CVVHDF, the clinical and laboratory indices improved and the patient could be extubated. Hemodialysis with CVVHDF mode has benefits in ARF, especially if the patient has unstable hemodynamics.
 Key words: Acute Renal Failure; CVVHDF; Hemodialysis, Laparotomy, Sepsis
 Citation: Bangun YG, Hidayat H. Management of acute renal failure with CVVHDF in a patient with sepsis after post exploratory laparotomy: a case report. Anaesth. pain intensive care 2022;27(1):131−134.
 DOI: 10.35975/apic.v27i1.2086
 Received: December 11, 2022; Reviewed: December 22, 2022; Accepted: January 12, 2023

Acute renal failure in newborns in the practice of a pediatrician of the future

Aims: The treatment of an acute renal failure has not received much research in Kazakhstan, whether focusing on adults or children. As a result, there is a lack of awareness about the condition of the field's knowledge as well as its challenges and prospects. Thus the goal is to identify and assess the studies that are currently accessible concerning the treatment of acute kidney failure in newborns or infants in the context of Kazakhstan experience. Study design: Literature review Methodology: MEDLINE, Cochrane Reviews, and Pedro were among the databases used to conduct the literature search. The conjunctions "AND" and "OR" were used with certain keywords. The articles' time range was restricted between 2018 and 2022 in order to only present the most recent facts. Papers discussing acute renal failure in infants only in Kazakhstan were included in the inclusion criteria. Results: Regarding the treatment of AKI in neonates in Kazakhstan, there are incredibly few available studies. The majority of trials involved individuals who were older. ESRD was more widely covered in conjunction with dialysis than AKI. Women are more prone to experience AKI turning into full-blown CKD. Conclusion: To learn more about the state of acute renal failure in neonates in Kazakhstan, more field study is required. The frequency and prevalence of placing new-borns on dialysis should be updated and made publicly accessible. It is important to emphasise the causes and risk factors of AKI in babies of Kazakh ancestry in order to comprehend current trends. Scientific Novelty: This is the first study that attempts to cover the status of pediatric acute renal failure management within Kazakhstan. It will serve as a starting point for prospective research on pediatric illnesses within the country, so as to understand where the health sector of Kazakhstan stands on the global stage.

RETRACTED: Internet of things medical image detection and pediatric renal failure dialysis complicated with respiratory tract infection

Acute Renal Failure in children in need of dialysis, peritoneal dialysis, hemodialysis, including intermittent and continuous blood filtration, or blood dialysis, can be managed in various ways. Selection of dialysis in the management of a particular patient, the goal of dialysis use of each model and institutional resources are determined by several factors, including the unique strengths and weaknesses. To provide practical guidance for physicians involved in managing acute renal failure in children, this review considers these aspects of acute renal failure management. Respiratory tract infections (genital tract infection) is a common reason people seek medical care services. Reproductive tract infection is associated with high short-term mortality. Inconsistent evidence exists concerning the risk of death of the patient's existence and reproductive tract infections of the kidney disease. Besides, the Company, together with respiratory infections, the main features of each type, is a complex common type of dialysis in children with renal failure. Finally, are open to detecting dialysis respiratory infections in children with renal failure, which is expected to facilitate future studies of the complex medical network of smart medicine and Internet issues when pointed out the application of deep reinforcement learning.

Early renal biopsy in acute renal failure - Expect the unexpected

Present study was carried out to determine the contribution of early renal biopsy in diagnosis and management of acute renal failure (ARF) cases suspected on clinical grounds to be other than acute tubular necrosis (non ATN-ARF). Total 37 cases fulfilled the inclusion criteria. In 20 out of 37 (54.05%) cases the clinical diagnosis was in concordance with biopsy diagnosis. In 13 out of 37 (35.13%) cases the clinical diagnosis was in discordance with biopsy diagnosis which altered the management of the patient. Remaining 4 out of 37 (10.81%) cases were not diagnosed clinically and diagnosis of ARF was totally based on renal biopsy. So overall management alteration in non ATN - ARF patients was 45.94% (17 out of 37 cases). Thus, early renal biopsy contributes to specific treatment and therefore the outcome of patients with non ATN–ARF. Keywords: Acute Renal failure, Acute tubular necrosis, Amyloidosis, glomerulonephritis, Multiple myeloma, Vasculitis.

To study renal parameters and serum calcium levels in birth asphyxia

Background: Birth asphyxia is a common neonatal problem and contributes significantly to neonatal mortality and long term morbidity. Any organ can be affected but the brain, heart, kidneys are more sensitive to hypoxic injury. Aim and Objective: To study renal parameters and serum calcium levels in birth asphyxia, to determine the incidence of renal failure in asphyxiated newborns, and to correlate the renal parameters with different severity of birth asphyxia and with different stages of hypoxic-ischemic encephalopathy. Method and material: A comparative study of 69 term newborns, appropriate for gestational age born/admitted to tertiary care Centre RDGMC Ujjain with birth asphyxia and 69 normal newborns without birth asphyxia was done. Perinatal history, physical examinations, New Ballard score, Apgar score was done. Data collected and entered in the master chart for results and analysis. Result: The study included 69 cases and 69 controls with the majority of boys. Mild, moderate, and severe birth asphyxia was7%, 29%, and 64% of all cases respectively. The incidence of acute renal failure was 57% among cases of birth asphyxia. The incidence of acute renal failure was 53% and 50% in hypoxic-ischemic encephalopathy stages III and II respectively. Incidence of renal failure with mild, moderate, and severe asphyxia was 40%, 50%, and 39% respectively Conclusion: Perinatal asphyxia is an important cause of neonatal renal failure. Monitoring of urea, creatinine and urine output helps in the early diagnosis and management of acute renal failure

Management of Acute Renal Failure in Septicemic Neonates at a Tertiary Care Hospital

Management of Acute Renal Failure in Septicemic Neonates at a Tertiary Care Hospital

Protocolo de tratamiento nutricional del paciente con insuficiencia renal

Acute renal failure induces a uremic environment that causes a hypercatabolic state, inflammation and malnutrition. Protein and energetic stores leak out. Simultaneously the adaptation mechanism to stress conditions or higher energy demand are impaired. Prognosis and evolution of patient with acute renal failure depend on his nutritional status. It is important to know the patient's dietary needs in each stage of the disease in order to prevent the state of malnutrition. The management of acute renal failure determine the prognosis, so when it appears, a correct assessment and treatment is required. In a practical way in the current paper we distinguish among patients with acute renal failure, chronic kidney insufficiency and in renal replacement therapy (hemodialysis and peritoneal dialysis); besides, nutritional treatment in each case will be described.

Acute Renal Failure in Children at the University Hospital of Brazzaville

Introduction: Acute renal failure (ARF) is a medical emergency that does not spare children. Its interest lies in the search for etiologies and management made difficult by the poor quality of hospital technical platform in Africa. Objectives: To improve the management of ARF in children, determine its prevalence, and identify the causes and factors associated with mortality. Patients and Methods: We reviewed the records of children from one month to 17 years hospitalized between January 2016 and December 2018 in every pediatric department at the University Hospital of Brazzaville and included those whose discharge diagnosis included the item “ARF”. Study variables were age, sex, source, (para)clinical signs, stage and type of ARF, etiology and evolutionary profile. Results: Included were 18952 hospitalized children out of whose 253 had ARF 1.3%. There were 145 (57.3%) boys and 108 (42.7%) girls with an average age of 71.5 months. The mean time to consultation was 8.1 days. ARF was at failure stage in 147 cases (58.1%). It was functional in 210 cases (83.0%), out of which 95.1% resulted from severe dehydration. No extra-renal treatment was performed. Lethality was 34.4%. Hypovolemic shock (56.3%), severe sepsis (18.4%) and severe malaria (14.9%) were the main causes. Young age, provenance of the child, severe dehydration, deep coma, oligoanuria, stage of failure, hyperkalemia, absence of an extra-renal purification center were factors associated with mortality (p Conclusion: The high prevalence of ARF and its lethality requires public health actions including proper management of dehydration and malaria but also the creation of an extra-renal purification center.

Técnica de reemplazo renal en la insuficiencia renal aguda del paciente crítico: novedades e incertidumbres

La insuficiencia renal aguda (IRA) es una complicación frecuente en los pacientes que ingresan en la Unidad de Cuidados Intensivos (UCI). Suele aparecer asociada a otras disfunciones orgánicas en el contexto de un síndrome de disfunción multiorgánica. Con frecuencia el manejo de la IRA en el paciente crítico requiere terapias de reemplazo renal (TRR) que pretenden sustituir la filtración renal alterada. Desde la aparición de las TRR hace más de 30 años, ha sido notable el avance en los conocimientos adquiridos y las mejoras en el manejo de los pacientes con IRA. Sin embargo la mortalidad de la IRA sigue siendo elevada y existen muchas controversias y poca claridad a la hora de aplicar las TRR, como momento de inicio y de retirada, la modalidad de tratamiento, la dosis, el tipo de anticoagulación etc. En los últimos años numerosos trabajos han intentado aclarar la falta de consenso existente en muchos de estos aspectos.

P266 Periodics lateralized épileptiform discharges recorded in a centro-pontic myelinolysis, A case report

Objectives For some authors, the PLEDs are the EEG expression of a dynamic physiopathological state in which an unstable neurobiological process creates a critical-intercritical continum in relation to the nature of the underlying neuro-neuronal damage, Pre-existing ability of the patient to develop epileptic seizures and the coexistence of metabolic disorder [1,2]. We report the case of a young patient with centro-pontic myelinolysis in whom PLEDS were recorded. Materials and methods Observation: a 25-year-old patient with no medical history, hospitalized in the internal medicine department for management of acute renal failure (ARI), cytolysis, severe hyponatremia, over 18 weeks pregnancy Of amenorrhea, poisoning with thistle algae was strongly suspected. During the hospitalization, the patient had convulsive seizures and then a status epilepticus. Results The first EEG (April 2010): awake, slowly waves, frequency at 06 C/S, presence of rapid rhythms in bi-anterior, a sign in favor of cerebral suffering. MRI (magnetic resonance imaging, March 2010): Aspect in favor of centro-pontic myelinolysis. The 2nd EEG (December 2010): absence of the background rhythm. Acute triphasic activity of continuous 2 C/S is observed, its amplitude is from 50 to 70 μ V predominant on the right diffusing towards the left hemisphere, reactive at the opening of the eyes, giving an appearance of PLEDs and bi PLEDS, Which is probably in favor of metabolic encephalopathy. The 3rd EEG (June 2011): normal EEG. Discussion Centro-pontic myelinolysis is the demyelination of the brainstem in this patient following a rapid correction of hyponatremia. PLEDs relate to acute non-specific dysfunction of cortical and/ or subcortical structures, described in rapidly evolving brain tumors, hematomas, strokes (Cerebral Vascular Accidents), encephalopathies, and are described in demyelinating pathologies and Anoxia. Neufeld et al. and Chu et al. Emphasizes the presence of underlying cerebral lesion associated with a metabolic disturbance in the production of PLEDs. Being a transient phenomenon the PLEDs disappeared during the 3rd EEG. Conclusion Our observation emphasizes the EEG expression of some demyelinating lesion in PLEDs, hence the value of performing an EEG to better understand their pathophysiology.

Leptospirosis: a report on a series of five autochthonous cases in a Greek region

Leptospirosis is a worldwide zoonotic disease difficult to diagnose both to the clinic and the laboratory. Many risk factors have been involved, such as planting, hunting, harvesting and butchering or sports, such as rafting. We reported our experience through a period of 20 months and we tried to investigate prognostic factors predicting clinical outcomes. Five male patients were admitted to our Department with a median age of 40 years. Overall, three out of five patients presented to other hospital and were transferred to ours with a wrong or delayed diagnosis. In terms of clinical signs and symptoms, all presented with fever, myalgia, headache and jaundice, whereas conjunctival suffusion was present in 80% of them. Acute renal injury and liver deficiency were diagnosed in all subjects. Acute renal failure management required dialysis in 3/5 patients, whereas renal recovery was achieved soon after clinical improvement. However, clinical awareness and serology are the most important tools for accurate and quick diagnosis in order to administer the appropriate therapy.

MP51-09 PRIMARY VERSUS DEFERRED URETEROSCOPY FOR MANAGEMENT OF CALCULUS ANURIA: A PROSPECTIVE RANDOMIZED TRIAL

INTRODUCTION AND OBJECTIVES: The role of ureteroscopy (URS) in management of acute renal failure caused by ureteral calculi could be primary or deferred after ureteral stenting. In this study we evaluate both approaches as regards the feasibility and clinical outcome. METHODS: Between January 2012 and December 2014, 150 patients with anuria / oliguria with a significant increase in serum creatinine due to ureteral stones (114 men and 36 women); including 72 solitary functioning kidney. Patients were prospectively randomized according to timing of ureteroscopic intervention into two groups; deferred URS group (69 patients who were treated initially by ureteral stenting then URS in another session) and primary URS group (81 patients who were treated by emergency URS). Follow up was at least 6 months postoperatively. RESULTS: Stone distribution was: 56% lower ureteral, 32% mid ureteral, and 12% upper ureteral. Both groups were comparable at presentation. Complete ureteroscopic stone clearance was 87 % and 75.3% for deferred and primary URS groups respectively (p1⁄40.097). Normal renal function returned in 94.2% of deferred URS vs. 97.5% of primary URS (p1⁄40.414). Deferred URS group had 2.9 % overall complication rate in comparison to 9.9 % for primary URS group (p1⁄40.109). Ureteral perforation/pyelonephritis was noted in 6.2% of primary URS group only (p1⁄40.043). Median number of maneuvers required till stone clearance was one (range 1-5) for primary URS vs. two (range 2-3) for deferred URS (p < 0.001). The cost of primary URS was significantly lower (p < 0.001). On multivariate analysis, lower ureteral calculi (OR 13.03, 95% CI 4.0741.7, p<0.001) and deferred URS (OR 2.84, 95% CI 1.077.49, p1⁄40.035) were independent predictors for eventless successful URS. CONCLUSIONS: Deferred URS is still the standard treatment for calculus anuria. Primary URS is feasible but technically demanding and has higher complication rate especially for middle/upper ureteral calculus anuria.

Acute Renal Failure Renal Replacement Therapy &amp; Outcome

Acute Renal Failure is an intractable problem, which can be actively and effectively managed, but can be prevented only to a little extent. Acute renal failure requiring dialysis is associated with high mortality and morbidity. In a study conducted by analyzing the literature and taking 15897 acute renal failure patients, it was found that mortality rates in most studies exceeded 30% [1]. Despite technical advancements in the management of acute renal failure over the last 50 years, mortality rates seem to have remained unchanged at around 50% [1]. In Kerala, the studies on acute renal shut down are sparse. Also the clinicodemographic profile of patients with acute renal failure varies in different parts of the world. Our objective was to study the clinicodemographic profile of acute renal failure patients who underwent renal replacement therapy and to identify the determinants of outcome at discharge or death. The present study is a retrospective cohort of 107 patients who required renal replacement therapy in Medical College, Thiruvananthapuram. The relevant data were collected from the case records of patients by a data collection sheet. Outcome was taken as survived or expired at the time of discharge or death. Continuous variables were represented as means and standard deviations. The statistical significance assessed by Odds ratio and Chi-square test. The present study had a mortality of 32.7% with women more prone. The average age of the subjects was 43.16±16.45 years. Univariate analysis of the variables with the outcome like women gender (p=0.490), pre-morbidities (p=0.079), only one comorbidity in a patient (p=0.769), oliguria on the day of Ist dialysis (p=0.549), oliguria on the next day of the Ist dialysis (p=0.363) and Liano’s score 0.3 & above on the day of Ist dialysis (p=0.065) were associated with increased mortality. Ages 45 years & above (p=0.006), sepsis syndrome (p=0.0008), more than one co-morbidity in a patient (p=0.032) and Liano’s score on the day after the Ist dialysis (p=0.024) were associated with obvious increase in mortality, which were statistically significant. Snake envenomation had the best prognosis (p=0.037) and serum creatinine level had weak association with outcome (p=0.065). The study conducted on 107 patients revealed 32.7% mortality. Snake envenomation had the best prognosis and sepsis syndrome the worst. Age 45 years & above and women gender were bad prognostic indicators. Pre-morbidities, co-morbidities and oliguria were probable bad indicators. Liano’s score 0.3 and above was a good predictor of mortality. Unfortunately, serum creatinine level had only weak association with the outcome.

Chrysanthemum indicumAttenuates Cisplatin-induced Nephrotoxicity bothin vivoandin vitro

Chrysanthemum indicum Linné has been used in traditional medicine to treat various inflammatory diseases in East Asia. The aim of the present study was to investigate the protective effect of C. indicum ethanol extract (CILE) against cisplatin-induced nephrotoxicity. An HPLC-photodiode array method was used for fingerprint analysis of the CILE and ten major constituents were quantitatively analyzed. The protective effect of CILE on cisplatin-induced nephrotoxicity was assessed using both in vitro (porcine kidney cell; PK15 cell) and in vivo (Sprague Dawley rat) experiments. In the in vitro study, CILE enhanced PK15 cell viability after cisplatin treatment with recovered antioxidant status. Moreover, the increased p53 expression after cisplatin treatment was decreased in the CILE pretreated cells. In the in vivo study, SD rats were treated for 28 consecutive days with CILE (0, 100, 300 and 500 mg/kg). On day 23, a single dose of cisplatin (5 mg/kg) was injected to induce nephrotoxicity. The CILE pretreated group showed recovered serum renal function index with ameliorated oxidative stress. Histopathological alterations and apoptosis in the kidney were also decreased in CILE pretreated rats. Taken together, CILE could attenuate cisplatin-induced nephrotoxicity and might be a beneficial agent for acute renal failure management.

Encuesta sobre el manejo del fracaso renal agudo y las técnicas de reemplazo renal en las unidades de cuidados intensivos españolas

AimTo analyze knowledge and experience in the diagnosis and management of acute renal failure (ARF) and the use of renal replacement therapy (RRT) in different Spanish Intensive Care Units (ICUs). DesignA case series with a survey conducted by the Nephro-Intensive Care Working Group of the SEMICYUC was compiled between January and November 2011. ScopeSpanish national ICUs. InterventionsA survey of 28 questions with multiple and open responses. ParticipantsThe survey was sent to 99 ICUs. Volunteers consisting of the medical staff belonging to the 51 ICUs that responded.Main variables of interest General characteristics of hospitals and ICUs, definitions of ARF and RRT (indications and management). ResultsRIFLE/AKIN scales to define ARF (47%). ARF diagnosis: plasma creatinine (80.4%), creatinine clearance (52.9%). Protocols for RRT: 72.5%. RRT in non-renal indications: 70.6%. Indications for initiation of RRT: oliguria, increased creatinine and urea. End of RRT: increased diuresis. RRT dose: 21-35ml/kg/h (41.2%), 36-45ml/kg/h (33.3%). ConclusionsThere is great variability in the ARF detection methods, and adequate incorporation of the RIFLE/AKIN systems to daily clinical practice in the ICU is still lacking. Written protocols aimed at establishing an early diagnosis of ARF are needed, based on these systems. On the other hand, there is growing interest in RRT, despite the fact that there are no definitive indications or guidelines on the use and handling of such techniques.

Continuous Venovenous Hemofiltration versus Continuous Venovenous Hemodiafiltration in Critically Ill Patients: A Retrospective Cohort Study from a Canadian Tertiary Centre

Studies comparing continuous renal replacement therapy modalities are lacking. Theoretically, continuous venovenous hemofiltration (CVVH) could be more effective than continuous venovenous hemodiafiltration (CVVHDF), and may be associated with fewer complications; however, there are no published data to support this hypothesis. To examine the effect of CVVH on mortality and other clinically important outcomes compared with CVVHDF in the intensive care unit (ICU) setting. Using a log of all continuous renal replacement therapy performed at a Canadian tertiary centre between 2007 and 2010, the records of patients meeting the inclusion criteria of being admitted to the ICU, and receiving either CVVH or CVVHDF for management of acute renal failure, were reviewed. The information retrieved included demographic data, death events, and hospital and ICU length of stay. Data from 153 patients were included in the present study. Hospital and 30-day mortality were similar in the CVVH and CVVHDF groups (OR 0.85 [95% CI 0.38 to 1.89]; P=0.69 and OR 1.35 [95% CI 0.62 to 2.95]; P=0.45, respectively). There was no difference in hospital length of stay (mean difference -34.14 [95% CI -72.92 to 4.65]; P=0.08). The present retrospective review suggests that the use of CVVH does not reduce mortality or hospital length of stay when compared with CVVHDF. Future randomized trials should control for different patient populations and continue to evaluate the removal of small molecules such as hormones.

The End of the Beginning

The End of the Beginning

A novel mechanism of NALP3 inducing ischemia reperfusion injury by activating MAPK pathway in acute renal failure

Acute renal failure (ARF) is a rapid loss of kidney function. The reasons and mechanism by which this occurs has not been clarified so far thus creating obstacles to management of this disease. Presently, the experimental research using the accepted renal ischemia reperfusion injury (I/R injury) model represented for ARF focuses on several possible relevant factors such as reactive oxygen species, no-reflow phenomenon, apoptosis and extensive inflammatory response. The latter is much talked about currently. Some intracellular danger sensing proteins, such as the nucleotide binding domain leucine rich repeats-containing family proteins known as NLRs, adjust the inflammatory response through the formation of a multi-protein complex known as an inflammasome. The most classic family member of this complex is NALP3 confirmed to serve as a contributor to I/R injury. However, how it contributes to the pathology remains obscure. The extensive inflammatory response is considered to be modulated by the mitogen-activated protein kinases (MAPK) signaling pathway. NOD2, another family member of NLR, which shares similar structure with NALP3, indicated that it induced the activation of MAPK in response to a pathogen, thus we assumed that NALP3 performed the harmful process of I/R injury, resulting probably from the activation of the MAPK signaling pathway. If this hypothesis proves to be correct, it might benefit the management of ARF.

Protocolo diagnóstico de la insuficiencia renal en el paciente oncológico

Acute renal failure (ARF) consists in a deterioration of the renal function produced suddenly (hoursdays-weeks). It consists in a decrease of glomerular filtration rate (GFR). The decrease in GFR leads to failure of nitrogenous waste products excretion with the consequent elevation of urea and creatinine and impossibility to maintain hydroelectrolytic balance. According to the etiology of ARF, its is considered prerenal, parenchymatous or obstructive origin. Management of ARF, independently of whether the patient is a cancer patient or not, includes treating the cause that has lead to the failure and medical treatment to avoid the worsening of the renal function while the cause is being resolved. On the other hand, there are more typical pictures of the oncology patient. These are tumor lysis syndrome and hepatorenal syndrome. These are also reviewed in this protocol.