Acute Renal Failure at a Crossroads

Acute renal failure in the intensive care (intensive therapy) unit, whilst the subject of this symposium, is but a microcosm of the field of acute renal failure in general. In many respects the field is at a crossroads, or a turning point. It is nearly 50 years since the first complete descriptions of acute renal failure appeared in English (Beall et al. 1941; Bywaters and Beall 1941; DeNavasquez 1940; Dunn et al. 1941; Mayon-White and Solandt 1941) and nearly 40 years since the publication of Oliver’s classic microdissection studies (Oliver et al. 1951; Oliver 1953). In the course of our professional careers since the early 1970s, there have been at least 16 meetings or symposia devoted to acute renal failure or nephrotoxicity, not counting the present gathering (Table 4.1). The emphasis has gradually shifted from characterization and dialytic treatment to prevention, early diagnosis, and specific pharmacological therapies. The first prospective human trials of intervention with atrial natriuretic peptide, calcium channel blockers, thyroxine, and oxygen free radical scavengers are just now getting underway, after many years of studies confined to the laboratory. It is likely that in the next few years an agent will be found which is as effective in reversing early acute renal failure as tissue plasminogen activator is in reversing early myocardial infarction (Thrombolysis in Myocardial Infarction Study Group 1985). A new International Acute Renal Failure Working Group has been formed, with links to the International Society of Nephrology, to strengthen international communication between physicians and scientists with an interest in acute renal failure, including many in the Third World countries where septic abortion, snake bite, and haemorrhagic fever are still common antecedents.