Abstract
The progress in the prevention and clinical management of shock-induced acute renal failure (ARF) during the past two decades has been impressive. In the area of pharmacologic intervention, many ways to prevent, to ameliorate, or to reverse ARF have been tried in animal models, often with success. However, very little of this apparently promising therapy has been found useful in clinical work to date. Volume expansion is of clear benefit in the prevention of ARF. To decrease the incidence ARF in cadaveric renal allograft recipients, treatment with calcium channel blockers seems possible. Although, the use of these drugs in the prevention of radiocontrast media-induced ARF has been reported to be promising, whether this therapy is ready to be used routinely in high-risk patients has not been determined. From the available data, it is difficult to make recommendations for pharmacologic interventions in other clinical situations of shock and ARF. What is seen in experimental models of ARF may not always be reproducible in clinical practice because the nature of insults is variable and difficult to time in the human setting.