BMJ  2006;333:406-407 (26 August), doi:10.1136/bmj.38945.596215.80

Editorial

Early intervention in acute renal failure

Give intravenous fluids, not loop diuretics

The first 150 words of the full text of this article appear below.

Oliguria and a rise in the plasma urea concentration are normal physiological responses to the haemodynamic changes associated with hypovolaemia, cardiac failure, or sepsis. Clinical decision making during the ensuing hours may determine whether a patient makes a speedy recovery or develops the serious complication of established acute renal failure. This condition still has a mortality of about 50%, despite recent improvements in clinical practice.¹ A meta-analysis in this week's BMJ by Ho and Sheridan reviews the evidence on one commonly used and cheap intervention—the loop diuretic furosemide (frusemide)—but finds it to be of little use in preventing or treating acute renal failure.²

Acute renal failure occurs in a variety of different circumstances and can complicate pre-existing chronic renal failure. The traditional split into prerenal, renal, and postrenal causes of acute failure is useful, if only to remind doctors of the need for a systematic approach to diagnosis and . . . [Full text of this article]

North Cumbria Acute Hospitals NHS Trust, West Cumberland Hospital, Whitehaven CA28 8JG
(David.Bennett-Jones@ncumbria-acute.nhs.uk)

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Articles

Early intervention in acute renal failure: Assessing fluid status is important

Jonathan M Gleadle
BMJ 2006 333: 551. [Extract] [Full Text]

Early intervention in acute renal failure: Evidence of inadequate intravenous fluid treatment in UK hospitals

Nicholas J Matheson, Sarosh R Irani, and Anushka Irani
BMJ 2006 333: 551. [Extract] [Full Text]

Meta-analysis of frusemide to prevent or treat acute renal failure

Kwok M Ho and David J Sheridan
BMJ 2006 333: 420. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

• Gleadle, J. M (2006). Early intervention in acute renal failure: assessing fluid status is important.. BMJ 333: 551-551 [Full text]  
• Matheson, N. J, Irani, S. R, Irani, A. (2006). Early intervention in acute renal failure: evidence of inadequate intravenous fluid treatment in UK hospitals.. BMJ 333: 551-551 [Full text]  

Rapid Responses:

Read all Rapid Responses

Early intervention in acute renal failure. The importance of assessing fluid status

Jonathan M Gleadle
bmj.com, 25 Aug 2006 [Full text]

Evidence of inadequate intravenous fluid therapy in UK hospitals

Nicholas J Matheson, et al.
bmj.com, 31 Aug 2006 [Full text]

Early intervention in acute renal failure

Timothy W Evans, et al.
bmj.com, 1 Sep 2006 [Full text]

Acute renal failure and the need for close collaboration between nephrologists and intensivists

Paul Frost, et al.
bmj.com, 3 Sep 2006 [Full text]

Early intervention in acute renal failure

Steve R Jones
bmj.com, 3 Sep 2006 [Full text]

The Correct Fluid

Duncan L A Wyncoll, et al.
bmj.com, 5 Sep 2006 [Full text]

Getting the Fluid into the Patient - practical problems with intravenous fluid managment

Margaret Owen
bmj.com, 11 Sep 2006 [Full text]