Acute renal failure

Editor—In her review of acute renal failure Hilton acknowledges that the immediate care of most such patients in the United Kingdom is provided in intensive care units by intensivists but does not sufficiently emphasise the effective clinical approach to resuscitation in intensive care.¹ In particular, adequate renal perfusion pressure must be maintained in patients who have a raised intra-abdominal pressure, and this can often prevent the need for renal replacement therapy.

Abdominal compartment syndrome occurs if the intra-abdominal pressure is greater than 20 mm Hg and associated with organ dysfunction such as oliguria.² If unrecognised or untreated a persistently raised intra-abdominal pressure can result in acute renal failure. This condition is well recognised by intensivists: three quarters of intensive care units measure intraabdominal pressure through the intravesical route.³ If abdominal compartment syndrome develops, acute renal failure can be prevented by continued fluid resuscitation, use of vasopressors, and decompression of the abdomen. Improved recognition of this condition by surgeons and physicians would benefit patient care.