Prevention of further injury to the kidney

The development of established ARF and the initiation of renal replacement therapy do not absolve the treating physician from continuing to take care of the damaged and, hopefully, recovering kidney. The recovering kidney is unable to maintain normal autoregulation of its blood flow and therefore is highly susceptible to hypotensive injury. Biopsy studies have confirmed the significance of this by showing areas of fresh ischemia in patients who are recovering from ARF and have sustained renewed septic or hypotensive insults. Therefore it is of great importance to continue to pay attention to all the factors mentioned in the previous discussion concerning the prevention of renal injury.

More recently, evidence has emerged (Hakim et al. 1995) that the type of membrane used during replacement therapy may make a significant difference to renal and patient recovery during ARF. While the issue of whether all patients with ARF should be treated with synthetic membranes remains controversial, cellulose-based membranes have certainly been shown to induce marked complement and leukotriene activation. This may be associated with delayed renal recovery as well as an increased incidence of sepsis when compared with synthetic (biocompatible) membranes. However, synthetic membranes appear capable of absorbing significant quantities of inflammatory molecules and thus may attenuate the inflammatory response associated with sepsis.

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