Hypertension when seen in ARF is invariably due to fluid overload. This situation is typically seen in acute post infectious nephritis and while acute control of blood pressure may be achieved using a vasodilator such as nifedipine, correction of the salt and water overload should be obtained using iv furosemide. In the presence of renal impairment increased doses of diuretics are needed. If the patient is anuric, fluid removal will require dialysis.
The renin-angiotensin system is not a major cause of hypertension in acute renal failure but ACE inhibitors are widely used in the treatment of more chronic forms of hypertension in both children and adults.
The main indications for dialysis in ARF are:
Fluid overload which leads to hypertension. While the patient is producing urine, aggressive use of diuretics can help maintain fluid balance, but once urine production has ceased further use of diurectics is ineffective and dialysis is the only way to remove fluid.
Hyperkalaemia which is not controlled by other therapies.
Acidosis which is not responding to other therapies.