Molecular mechanisms of recovery from acute renal failure.

OBJECTIVES: Despite technological advances in renal replacement therapy over the past few years, acute renal failure in the intensive care unit remains associated with high morbidity and mortality rates. In this article I review recent research aimed at elucidating mechanisms of renal recovery from acute injury.
DESIGN: Review of the literature.
CONCLUSIONS: A number of peptide growth hormones are reviewed, including epidermal growth factor, insulin-like growth factor-1, thyroxine, hepatocyte growth factor, and bone morphogenetic protein-7 promote renal regeneration in model systems. Unfortunately, despite promising studies in animal models of toxin and ischemia-induced acute tubular necrosis, human studies have not shown any clinical benefit. However, several of these molecules have not been studied in clinical trials. Existing pharmacologic strategies have a limited role in renal recovery. Finally, several recent studies have focused on the effects of renal replacement therapy on renal recovery, but additional studies are needed to confirm and extend these results.