Prevailing Patterns and Predictor Variables in Patients With Acute Tubular Necrosis

McMurray, Stephen; Luft, Friedrich C.; Maxwell, D. R.; Hamburger, Richard J.; Futty, Dennis E.; Szwed, James J.; Lavelle, Kevin J.; Kleit, Stuart A.

doi:10.1001/archinte.1978.03630310040016

Cited by 121 publications

(22 citation statements)

References 8 publications

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“…Up to 53% of ATN occurred in patients over 59 years of age, confirming that the population affected by ATN is becoming older [1,3,10,13,40], With univariate analysis, we did not find an influence of age on prognosis, as we pre viously reported [41] in agreement with some authors [1,10,28,29,33] and in contrast with others [11,13,14,31,36,40], However, age had a significant influence on mortality with our multiple linear regression analysis. Several variables could have a significant incidence on prognosis using multiple regression even though the effect cannot be proved with the univariate approach [23].…”

Section: Discussionsupporting

confidence: 91%

Prognosis of Acute Tubular Necrosis: An Extended Prospectively Contrasted Study

Liaño

Gallego²,

Pascual³

et al. 1993

Nephron

198

128

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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.

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Section: Discussionsupporting

confidence: 91%

Prognosis of Acute Tubular Necrosis: An Extended Prospectively Contrasted Study

Liaño

Gallego²,

Pascual³

et al. 1993

Nephron

198

128

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“…It is of note, however, that there is little agreement as to what constitutes adequate, let alone opti mum, nutritional support. Several studies have demonstrated that some protein is better than none [7][8][9], but the composition in terms of essential or nonessential amino acids, or the exact amount in grams per kilogram per day, is still in considerable doubt. Of perhaps less controversy is that adequate energy is beneficial.…”

Section: Nutritional Considerations In the Choice Of Therapymentioning

confidence: 99%

Extracorporeal Blood Purif ication in the Treatment of Acute Renal Failure with Multiorgan Involvement

Kaplan

1996

Blood Purif

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It has been more than 35 years since the early use of dialytic techniques for the treatment of acute renal failure. Considering the survival of patients who would have clearly succumbed to renal failure, attempts were made to determine at what level of uremic toxicity it would be beneficial to offer dialysis on a prophylactic basis. Those early attempts at defining a preventive strategy seemed to provide an improved survival by limiting incidence and severity of hemorrhage and sepsis. Subsequently, measurable advances have been difficult to attain, and the prognosis of complicated acute renal failure remained dismally poor. More recently, continuous renal replacement techniques were developed to offer a more physiologic treatment to those patients who were the most critically ill and unstable. These treatments offered the potential for a better tolerated fluid removal and a more constant control of electrolyte and acid-base balance. Other potential advantages included the use of more biocompatible membranes and the convective mode of solute transfer with its inherently greater removal of larger molecular weight substances such as the vasodilatory and inflammatory cytokines. Another approach has been to use extracorporeal purification to lower the levels of endotoxin, a goal which can be accomplished by either standard plasma exchange or, more elegantly, the use of selective adsorption columns. Despite the promise of these methodologies, the lack of an acceptable grading system for the severity of critical illness has hampered investigators who have tried to prove the eventual advantage of one blood purification technique over another.

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“…Me Murray al. [49], in a retrospective study, found that treatment with ENAA improved survival in patients with severe complicating illnesses. Another retrospective study concluded that ENAA treatment was associated with decreased survival in comparison to a historical control group which received EAA [50].…”

Section: Optimum Nutritional Intake In Arfmentioning

confidence: 99%

Parenteral Nutrition in Acute Renal Failure

Feinstein¹

1985

Am J Nephrol

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Prevailing Patterns and Predictor Variables in Patients With Acute Tubular Necrosis

Cited by 121 publications

References 8 publications

Prognosis of Acute Tubular Necrosis: An Extended Prospectively Contrasted Study

Prognosis of Acute Tubular Necrosis: An Extended Prospectively Contrasted Study

Extracorporeal Blood Purif ication in the Treatment of Acute Renal Failure with Multiorgan Involvement

Parenteral Nutrition in Acute Renal Failure

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