DISEASE OF THE MONTH Hospital-Acquired Acute Renal Failure

Acute renal failure (ARF) is the abrupt loss of renal function sufficient to decrease urinary elimination of nitrogenous waste (urea nitrogen and creatinine). Although there is consensus about this general definition, few agree on the magnitude of the rise in serum eneatinine necessary to ascribe a diagnosis of ARF (1,2). These differences in definition plus variances in methods of patient accrual, populations analyzed, and eategorization of causes render development of a broad-based overview of ARF difficult. However. two generalizations about contemporary ARF are compelling. First, ARF is predominantly a hospital-acquired disorder (1-3). Second, the high mortality of patients with ARF is not explained entirely by comonbid conditions. Recent data indicate that ARF per se increases the risk of development of multiple nonrenal conditions that lead to death and disability (4). Thus, ARF should not always be considered a treatable condition that complicates advanced disease. Together, these two generalizations prompt this review, which focuses on the causes, diagnosis, prevention, and management of hospital-acquired ARF.