immediate treatment of acute renal failure (ARF)

Management

• Rule out pre-renal & post-renal etiologies of ARF
  • foley catheter
  • fluid challenge is indicated (500 mL of normal saline)
• discontinue all nephrotoxic agents
• mannitol 12.5-25 g IV plus furosemide 20 mg IV
• if urine out < 60 mL/hour, treat with furosemide 400-500 mg IV
• if response is > 60 mL/hr
  • begin 20% mannitol infusion, 20-40 mL/hr (< 100 g/24 h)
  • furosemide 200 mg PRN to maintain urine output > 60 mL/hr
  • replace urine 1:1
• avoid high doses of furosemide (ototoxicity)
• dopamine drip (renal dose)
• consider specific methods
  • forced alkaline diuresis
    • uric acid
    • myoglobin (rhabdomyolysis)
    • methotrexate
  • chelation

Additional terms

• acute renal failure (ARF)