Acute renal failure: the new perspectives.

This review updates the progress which has been made in the recent years in the field of diagnosis, prevention and treatment of acute renal failure (ARF). Despite the better recognition of the etiology and risk factors of ARF this disease is still characterized by high mortality especially when developing in patients with multi-organ failure. The origin of ARF is clearly multifactorial but its pathomechanism shows many similarities regardless of a cause. Due to the latest achievements in the understanding of the pathogenesis of ARF better preventive and therapeutic strategies are being developed. Some of them have been successfully tested in experimental settings. Surprisingly most of the human studies showed that preventive methods other than simple hydration could not change the course of the disease or even could be harmful. Also the critical issue remains early ARF detection. In turn in cases of fully developed acute tubular necrosis the major concern is to prevent secondary complications and organ failure and to introduce appropriate dialysis therapy. Although not yet supported by a significant reduction in mortality in most severe cases of ARF some progress has been made due to the development of new convective intermittent or continuous renal replacement therapies, notably hemodiafiltration.