Acute renal failure in patients with ischemic heart disease: causes and novel approaches in breaking the cycle of self-perpetuating insults abrogated by surgery.

At present, there seems to be diametrically opposing views on the causes of acute renal insufficiency in patients with ischemic heart disease (IHD) elective for cardiac revascularization. In this review, we examined recent advances in the understanding of the pathophysiology of acute renal failure in patients with IHD and surgery-induced acute phase reaction. Emphasis is given to the cellular and molecular mechanisms that contribute to the initiation and progression of inflammation. We evaluated the different pharmacological, technical, and surgical strategies used to improve the outcome of patients with IHD with impaired renal dysfunction and analyzed the influence of renal insufficiency on long-term results after surgery.