Hospitals & Services
The cornerstones of good renal protection are not the administration of various drugs, but good clinical practice ie:
Adequate fluid resuscitation (sometimes a difficult concept)
Haemodynamic support to maintain both a good renal perfusion pressure and adequate blood flow. Where necessary this may involve inotrope and/or vasopressor support. Despite historical anxiety about the use of vasopressor (Noradrenaline), it is not harmful to the kidneys and may in fact increase renal blood flow in animal studies.
Avoid nephrotoxic drugs where necessary
Treat intercurrent infection
Active surveillance for abdominal compartment syndrome, where this is appropriate.
Low dose domamine and frusemide have been used to promote urine output, but have not been found to impact on progression to dialysis or mortality.
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