The management of<unk>  hinges on identification and treatment of the underlying cause. The main objectives of initial management are to prevent cardiovascular collapse and death and to call for specialist advice from a nephrologist. In addition to treatment of the underlying disorder, management of<unk>  routinely includes the avoidance of substances that are toxic to the<unk> s, called nephrotoxins. These include NSAIDs such as ibuprofen or naproxen, iodinated contrasts such as those used for CT scans, many antibiotics such as gentamicin, and a range of other substances. Monitoring of<unk>  function, by serial serum creatinine measurements and monitoring of urine output, is routinely performed. In the hospital, insertion of a urinary catheter helps monitor urine output and relieves possible bladder outlet obstruction, such as with an enlarged prostate. Prerenal In prerenal<unk>  without fluid overload, administration of intravenous fluids is typically the first step to improving<unk>  function. Volume status may be monitored with the use of a central venous catheter to avoid over- or under-replacement of fluid. If low blood pressure persists despite providing a person with adequate amounts of intravenous fluid, medications that increase blood pressure (vasopressors) such as norepinephrine, and in certain circumstances medications that improve the heart's ability to pump (known as inotropes) such as dobutamine may be given to improve blood flow to the<unk> . While a useful vasopressor, there is no evidence to suggest that dopamine is of any specific benefit and may in fact be harmful. Intrinsic The myriad causes of intrinsic<unk>  require specific therapies. For example, intrinsic<unk>  due to vasculitis or glomerulonephritis may respond to steroid medication, cyclophosphamide, and (in some cases) plasma exchange. Toxin-induced prerenal<unk>  often responds to discontinuation of the offending agent, such as ACE inhibitors, ARB antagonists, aminoglycosides, penicillins, NSAIDs, or paracetamol. The use of diuretics such as furosemide, is widespread and sometimes convenient in improving fluid overload. It is not associated with higher mortality (risk of death), nor with any reduced mortality or length of intensive care unit or hospital stay. Postrenal If the cause is obstruction of the urinary tract, relief of the obstruction (with a nephrostomy or urinary catheter) may be necessary. Renal replacement therapy Renal replacement therapy, such as with hemodialysis, may be instituted in some cases of<unk> . Renal replacement therapy can be applied intermittently (IRRT) and continuously (CRRT). Study results regarding differences in outcomes between IRRT and CRRT are inconsistent. A systematic review of the literature in 2008 demonstrated no difference in outcomes between the use of intermittent hemodialysis and continuous venovenous hemofiltration (CVVH) (a type of continuous hemodialysis). Among critically ill patients, intensive renal replacement therapy with CVVH does not appear to improve outcomes compared to less intensive intermittent hemodialysis. However, other clinical and health economic studies demonstrated that, initiation of CRRT is associated with a lower likelihood of chronic dialysis and was cost-effective compared with IRRT in patients with<unk> . Complications Metabolic acidosis, hyperkalemia, and pulmonary edema may require medical treatment with sodium bicarbonate, antihyperkalemic measures, and diuretics. Lack of improvement with fluid resuscitation, therapy-resistant hyperkalemia, metabolic acidosis, or fluid overload may necessitate artificial support in the form of dialysis or hemofiltration. However, oliguria during anesthesia may predict<unk> , but the effect of a fluid load is highly variable. Striving toward a predefined urine output target to prevent<unk>  is futile. Early recovery of<unk> <unk>  recovery can be classified into three stages 1–3 on the basis of the inverse of the<unk>  KDIGO serum creatinine criteria.
Acute kidney injury
Acute liver failure
Kidney ischemia
Renal ischemia
Papillorenal syndrome
Nephritic syndrome
Monofixation syndrome
Conorenal syndrome