The optimization of renal function in acute illness.

The development of acute renal failure increases the morbidity, the mortality and the duration of hospital stay of all patients who are treated in intensive-care units. Consequently, the prevention of renal failure, and especially that of oliguric acute renal failure, has a high priority in the management of patients who are seriously-ill. The identification of risk factors, the pretreatment of patients who are in high-risk categories and the maintenance of adequate hydration, oxygenation, cardiac output and renal blood flow are the first-line priorities in management. The use of loop diuretic agents, mannitol and dopamine, separately or in combination, probably are effective prophylactic measures. They also may have therapeutic benefit in the maintenance of a non-oliguric state in the presence of acute renal failure, although there is less scientific support for this role. Such manoeuvres are worthy of trial before an oliguric state is accepted. They are more likely to be efficacious if they are instituted early.