Akutní selhání ledvin u kriticky nemocnýcha možnosti jeho prevence

Acute Renal Dysfunction in Critically Ill Patients and itsPrevention

Acute renal failure often complicates the course of critically illness and can contribute to highmorbidity and mortality.In most cases acute renal failure represents a part of the multiple organ dysfunction syndrome and it is usually relatedto the ischemic and/or toxic injury of tubular cells (acute tubular necrosis, ATN). The presented paper reviews themechanisms involved in this two types of tubular cells injury. It analyzes the measures of kidney protection duringcritical illness, which include optimization of systemic and intrarenal hemodynamics as well as avoidance ofnephrotoxic drugs. It describes the most common nephrotoxic drugs and proposes principles of their safer use.Potential strategies to stimulate kidney function recovery are also discussed.

Key words:
acute renal failure, multiple organ dysfunction syndrome, acute tubular necrosis, hypoxia, renal perfusion,shock, nephrotoxic drugs, myoglobin, prevention.