Treatment

Any hypovolaemia should be remedied; for example features such as postural hypotension, should be treated with normal saline given rapidly intravenously. Uncertainty about fluid status indicates use of a central venous pressure line.

Urine flow can be facilitated by:

• high dose frusemide by slow infusion: Note that if gentamicin is also being given (e.g. for septicaemic shock) then the ototoxic effects of gentamicin will be potentiated by concurrent use of frusemide
• renal dose dopamine (1-5 mcg/kg/min)

Specialist advice should be sought before using diuretics. Diuresis may be of assistance in the management of ATN because there appears to be a better prognosis for this condition when it is in the non-oliguric phase, rather than the initial oliguric phase. It is accepted that diuresis is of benefit in managing plasma concentrations of potassium and management of the intravascular volume.

In some cases haemofiltration may be needed.

There is evidence that mannitol, with or without frusemide, if given before or very soon after development of acute tubular necrosis may reduce the extent of kidney damage.