The ability to predict the outcome in acute tubular necrosis (ATN) remains elusive despite considerable efforts. Accurate prediction is a crucial priority and has large economical and ethical implications, mainly to judge when treatment is futile and further efforts only prolong miserable agony. To analyze the influence of risk factors in the prognosis of ATN, we applied, in an initial phase, a prospective protocol of demographic data, cause of renal failure, diuresis, need of dialysis and clinical conditions in 228 patients using multiple linear and logistic regression models. In a control phase with 100 consecutive patients, we checked the accuracy of the results previously obtained, evaluating further the overall population of 328 patients in a synthetic phase. Finally, the validation of the equations obtained was verified in 25 patients from another hospital. As a complement of this 4-phase study, detailed statistical comparisons between both linear and logistic multiple regression models were undertaken. Correlation between probability of death obtained with equations from the initial phase applied to control patients and real evolution of these patients, survival or death, was excellent. The study of the synthetic phase revealed coma, assisted respiration, hypotension, oliguria and jaundice as having an independent positive influence on mortality and nephrotoxic etiology and normal consciousness on good prognosis. For the linear model, the same cut-off point of discriminant score (0.9) above which there were no chances for survival could be established in the 4 phases. With the logistic model, it only was found at later phases. The multiple linear was better than the logistic regression model in terms of better correlation with real mortality, better sensitivity and specificity intervals, easier use of discriminant cut-off point and better adjustment of distribution of standardized residuals to expected normal function. Early prognosis of ATN is possible and can be given using simple clinical features. A discriminant score allows to distinguish patients without chances for survival. The multiple linear is better than the logistic regression model in the prediction of the outcome in ATN.

No abstract

Background/Aim: The levels of C-reactive protein (CRP) have been related to hypoalbuminemia and the necessity of erythropoietin in patients on maintenance hemodialysis. However, in several studies, the patients’ clinical situation is not taken into account. The aim of the present work was to analyze the relationship between CRP and serum albumin and hemoglobin and the erythropoietin resistance index (ERI) in a population of patients on chronic hemodialysis classified according to their clinical situation. Methods: In a cohort of 53 patients followed for 12 months, we analyzed the CRP level and its association with albumin and hemoglobin levels and the ERI (ratio of total weekly erythropoietin dose in units/weight to hemoglobin concentration in g/dl) at the start of the study and at 6 and 12 months thereafter. The patients were divided into three groups based on the presence of inflammatory/infectious disorders during the 4 weeks prior to CRP determination (group A) or the use of a jugular catheter (group B) or an arteriovenous fistula (group C) as vascular access for hemodialysis. Results: At baseline, the CRP levels (47.1 mg/l in group A, 30.7 mg/l in group B, and 9.4 mg/l in group C) and the ERI (23.9 in group A, 24.6 in group B, and 10.7 in group C) were higher in groups A and B than in group C (p < 0.001 for both parameters). Serum albumin (3.9 g/dl in group A, 4.1 g/dl in group B, and 4.4 g/dl in group C) and hemoglobin (10.4 g/dl in group A, 11.3 g/dl in group B, and 12 g/dl in group C) were lower in groups A and B than in group C (p < 0.05 for serum albumin and p < 0.01 for hemoglobin). In all patients, the baseline CRP level correlated with the albumin level (r = –0.3853, p < 0.01), with the hemoglobin level (r = –0.2950, p < 0.05), and with the ERI (r = 0.4378, p < 0.01). However, if we only considered the group C patients, there was no correlation between baseline CRP and albumin, hemoglobin, and ERI. Similar results were observed at 6 and 12 months. Conclusions: The CRP, albumin, and hemoglobin levels and the ERI mostly depend on the existence of ongoing inflammatory/infectious disorders and the use of a catheter as vascular access. In the absence of these clinical conditions, we could not correlate the CRP level with the other parameters. The relationship between CRP, albumin, and anemia may be an epiphenomenon

The influence of body iron stores on the concentration of serum erythropoietin was studied in 48 hemodialyzed patients not receiving human recombinant erythropoietin, androgens or iron supplements. The serum erythropoietin concentration was 11.6 ± 10.4 mlU/ml. There was no correlation between the serum erythropoietin and the hematocrit or hemoglobin concentration; however, there was a correlation between the serum erythropoietin and the log of serum ferritin (r = -0.5699, p < 0.01). Serum erythropoietin levels were higher in the 18 ferropenic patients (serum ferritin < 50 ng/ml) than in the 30 patients with normal serum ferritin concentration (18 ± 13.8 vs. 7.8 ± 4.7 mlU/ml, p < O.01). The administration of intravenous iron to the ferropenic patients resulted in a reduction in serum erythropoietin independent of the respone of the anemia (18 ± 13.8 basal and 7.9 ± 6.5 mIU/mlat4weeks, p < 0.01). Our data would suggest that the concentration of erythropoietin in hemodialyzed patients is influenced by the serum ferritin level.

Eight patients with end-stage renal disease secondary to systemic lupus erythematosus (SLE) received 8 cadaveric renal allograft. Patient and graft survival was 100 and 87%, respectively. None of them showed extrarenal manifestations of SLE or recurrence of lupus nephritis after grafting. One graft was lost because of chronic rejection. In another patient, an episode of graft function deterioration due to bad control of arterial hypertension was observed. Three patients were transplanted during their first year on hemodialysis. Two women became pregnant after successful kidney transplantation; one suffered a spontaneous abortion and the other had a successful delivery. In neither of them, was SLE observed during or after pregnancy. Morbidity was low in this series, and infections were the most frequent complication. In summary, our experience with renal transplantation in SLE patients compares, favorably with the general nodiabetic transplanted population.