PREVENTION

The most effective prevention strategy is to maintain euvolemia in hospitalized patients and to avoid excessive exposure to nephrotoxic agents, especially in patients with preexisting renal disease.

In situations where ATN could be expected, such as during administration of intravenous radiocontrast, maintaining euvolemia and limiting the dye load might be expected to reduce the risk of this complication. Other measures—including the use of antioxidants, natriuretic peptides, and high dose flurosemide/mannitol—have not been shown to consistently decrease the risk of ATN.

Multiple risk scores have been devised to predict which patients are at highest risk for developing ATN and which will have the poorest outcome. The risk factors overlap, and they include variables that predict preexisting histologic damage and at predispose to renal ischemia, including male sex, advanced age, comorbid illness, malignancy, volume depletion/oliguria, sepsis, and multiorgan failure.