EARNEST ALEXANDER and BRADLEY A. BOUCHERNEW DIRECTIONS IN THE TRE TM NT OF CANCER Acute Renal Failure and the Critically Ill Patient

Acute renal failure (ARF) is a complication frequently ob-served in critically ill patients. This review provides details regarding the epidemiology and overall care of the ARF pa-tient. ARF is defined and classified based on etiology. These classifications are prerenal azotemia, ischemic ARF, and postrenal azotemia. Examples of drug-induced nephrotoxicity are also outlined. Clinical presentation and diagnostic criteria of ARF are differentiated among themajor ARF classes, andmanagement strategies are outlined. These management strategies include preventive, supportive, phar-macologic, and nonpharmacologic interventions. Current standards of practice and investigational therapies are also discussed. Pharmacokinetic monitoring and dosing regimen adjustments in ARF patients with and without renal replace-ment therapy are reviewed. Finally, a prognostic evaluatio