Key messages

• Restoration of renal perfusion by optimization of blood volume and correction of low cardiac output and hypotension are the most important objectives for achieving improved renal function.

• Speed in initiating treatment is particularly important in preventing progression to established acute tubular necrosis.

• Dopamine and diuretics are frequently administered to improve urine output but their efficacy in reducing the need for acute renal replacement therapy has not been substantiated by prospective controlled clinical trials.

• The use of natriuretic peptides awaits the results of further clinical studies.

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