[Treatment for acute renal failure--concepts and controversies. 1. Pharmacologic treatment and experimental strategies].

Acute renal failure is the common result of various damaging mechanisms. Prophylaxis and differentiated therapy of acute renal failure are of outmost importance in anaesthesiology and intensive care medicine. The efficiency of pharmacotherapy is narrowly limited. Diuretics increase the urine output, but they do neither ameliorate the clinical course of the patient nor the prognosis of established acute renal failure. Dopamine and natriuretic peptides have no use in prevention and treatment of acute renal failure. Calcium-channel-blockers are valuable in cadaveric kidney transplantation. Osmodiuretics prevent intratubular precipitation of hemoglobin and myoglobin crystals; they also have some value in cadaveric kidney transplantation. Experimental studies investigated the possibility to enhance the regeneration of the tubular epithelial cell. Whereas in vitro studies and studies in animal models using various growth factors yielded promising results, these could not be reproduced in patients with acute renal failure. The physiology of NO in the kidney is incompletely understood. Actual progress is made in the understanding of lipid peroxidation and potential pharmacological implications. The mainstay for the assurance of high-quality patient care remain a vigilant identification of the patient at risk and an arduous search to avoid nephrotoxic substances and situations implicating potential renal damage.