Acute Renal Failure in the Critically Ill Patient: Is there a Magic Bullet?

Acute renal failure has been a clinical challenge over the last five decades. In 1972, Stott and colleagues [1] reflecting on the high mortality from acute renal failure over the preceding two decades, posed the question “Why the persistently high mortality in acute renal failure?”. Over the subsequent 30 years, the same question has been repeatedly asked; in 1983, “Persistent high mortality in acute renal failure: Are we asking the right questions?” [2]; in 1986, “Acute renal failure — The continuing challenge” [3]; and in 1996, “Still lethal after all these years” [4]. Although there have been more optimistic reports recently [5–7], the fact remains that, in spite of the advances in all aspects of medical care over the last 50 years, acute renal failure in 2002 still carries a mortality of 50 to 60%, little changed from the 1950s [5, 8, 9]. This chapter will focus on the current state of therapy for acute renal failure.