Treatment for Intrinsic ARF

The goal of treatment for intrinsic ARF is to resolve the underlying cause and its complications. In nephrotoxic ARF, the toxins are eliminated, and in ischemic ARF, adequate blood flow to the kidneys is restored.

Acute glomerulonephritis and vasculitis are treated with glucocorticoids and plasmapheresis (plasma exchange). In allergic interstitial nephritis, the drug causing the condition is discontinued and glucocortoids are given. Malignant hypertension is treated with ACE inhibitors to control blood pressure.

Treatment of ARF Complications

  • Intravascular overload
    • Salt and water restriction
  • Hyponatremia (low sodium level in blood)
    • Water restriction
  • Hyperkalemia (high level of potassium in the blood)
    • Dialysis
    • Dietary potassium restriction
    • Sodium bicarbonate
  • Metabolic acidosis
    • Dialysis
    • Dietary protein restriction
    • Sodium bicarbonate
  • Hyperphosphatemia
    • Dietary phosphate restriction
  • Hypocalcemia
    • Calcium carbonate
    • Calcium gluconate
  • Hypermagnesemia
    • Discontinuation of magnesium-containing antacids (e.g., Maalox)

Indications for dialysis include the following:

  • Hyperkalemia
  • Nonresponsive intravascular overload
  • Severe acidosis resistant to other treatments
  • Uremia

Intrinsic ARF Prognosis

Mortality rates vary depending on the cause. Approximately 30% of patients with toxin-related intrinsic ARF and approximately 60% of patients with intrinsic ARF as a complication of major cardiovascular surgery die. The prognosis is poor when oliguria is present, in older patients, and in patients with multiple organ failure.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 30 Apr 2001

Last Modified: 27 Aug 2015