Acute Renal Failure
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Acute renal failure (ARF) or acute kidney injury (AKI), defined as a measurable increase in the serum creatinine (Cr) concentration (usually relative increase of 50% or absolute increase by 44–88 μmol/L [0.5–1.0 mg/dL]), occurs in ~5–7% of hospitalized pts. It is associated with a substantial increase in in-hospital mortality and morbidity. AKI can be anticipated in some clinical circumstances (e.g., after radiocontrast exposure or major surgery), and there are no specific pharmacologic therapies proven helpful at preventing or reversing the condition. Maintaining optimal renal perfusion and intravascular volume appears to be important in most clinical circumstances; important cofactors in AKI include hypovolemia and drugs that interfere with renal perfusion and/or glomerular filtration (nonsteroidal anti-inflammatory drugs [NSAIDs], angiotensin-converting enzyme [ACE] inhibitors, and angiotensin receptor blockers).