immediate treatment of acute renal failure (ARF)

Management: 1) Rule out pre-renal & post-renal etiologies of ARF a) foley catheter b) fluid challenge is indicated (500 mL of normal saline) 2) discontinue all nephrotoxic agents 3) mannitol 12.5-25 g IV plus furosemide 20 mg IV 4) if urine out < 60 mL/hour, treat with furosemide 400-500 mg IV 5) if response is > 60 mL/hr a) begin 20% mannitol infusion, 20-40 mL/hr (< 100 g/24 h) b) furosemide 200 mg PRN to maintain urine output > 60 mL/hr c) replace urine 1:1 6) avoid high doses of furosemide (ototoxicity) 7) dopamine drip (renal dose) 8) consider specific methods a) forced alkaline diuresis 1] uric acid 2] myoglobin (rhabdomyolysis) 3] methotrexate b) chelation

References

Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 597