Post-traumatic acute renal failure: its pathophysiological basis and treatment

Abstract

Acute post-traumatic renal failure is one of the most serious complications that can affect polytrauma patients, with a high morbidity and mortality. The kidney is vulnerable to developing acute renal failure by virtue of the arrangement of its blood supply and the high metabolic demands involved in the production of urine. While several intrinsic mechanisms exist to protect the kidney, these may be swamped following polytrauma. In particular haemorrhage and hypotension can lead to early renal failure; and the massive release of cytokines occurring in the systemic inflammatory response syndrome can lead to renal failure as part of the multiorgan failure syndrome. Early initiation of a renal protection protocol, followed by early conversion to renal replacement therapy if failure develops, reduces both morbidity and mortality. Continuous veno-venous haemofiltration mimics normal production of a glomerular filtrate and forms the basis of renal replacement strategies. It has several potential complications, but modern computerized systems have minimized these.