Prevention of acute renal failure.

Acute renal failure (ARF) complicates the clinical course of many critically ill patients and significantly adds to their morbidity and mortality. Efforts to develop techniques to prevent ARF or to facilitate its resolution largely have been unsuccessful. Aggressive hydration, minimizing nephrotoxins, and maintenance of "adequate" mean arterial pressure remain the main nonpharmacologic strategies to prevent ARF in the ICU. Increasing insight into mechanisms that lead to ARF prompted investigators to evaluate the role of novel therapeutic agents in the prevention of ARF. Recent data suggest that N-acetylcysteine may reduce the incidence of ARF secondary to radio-contrast agents.