芸香 = 橘子

【Nonpharmacologic Prevention】

雖然說要避免使用nephrotoxitic agents，但臨床上常遇到非用不可的情況！此時就需要額外的療法來預防ARF發生機率

• Radiocontrast(顯影劑)

① 適量hydration + Na loading à給予足量NaCl 0.9 %
Infusion 1mL/kg/hr 或 口服(臨床上還蠻常用的)

② 近來有些研究指出，加入適量的Na bicarbonate於NS中效果更加，因為NB可以降低PH-dependent O₂ free radicals(nephrotoxitic)的生成。

※ RRT for radiocontrast to prevent ARF???
普遍認為成效不彰或是根本沒有效果，因為顯影劑所致ARF發生在投予後數分鐘之內，以血液透析方式根本來不及！
但有人提出使用hemofiltration(血液過濾術=CRRT)，發現若於使用顯影劑後立即使用24小時，可以減少致死率！

※ hemofiltration, also haemofiltration, is a renal replacement therapy similar to hemodialysis. It is a slow continuous therapy in which sessions usually last between 12 to 24 hours and are usually performed daily. During hemofiltration, a patient's blood is passed through a set of tubing (a filtration circuit) via a machine to a semipermeable membrane (the filter) where waste products and water are removed. Replacement fluid is added and the blood is returned to the patient

•  Amphotericin B

 (1) For fungal infection, 30 % ARF incidence

 (2) 減少infusion rate(原先4hrsà24hrs)

 (3) 或用liposomal forms取代