Uncomplicated Acute Renal Failure and Post-Hospital Care: A Not So Uncomplicated Illness

Abstract

Background: Although uncomplicated acute renal failure (ARF) is associated with significant hospital resource utilization, its health care requirements following hospital discharge are not well understood. The goal of this study was to characterize the post-hospital care requirements incurred by patients with uncomplicated ARF and to determine its important influencing factors. Methods: We obtained hospital case mix data sets for a 2-year period (1999–2000) from the Massachusetts Division of Health Care Finance and Policy. Utilizing DRG and ICD-9-CM codes from 23 Massachusetts hospitals, we identified 2,128 adult patients whose primary reason for hospitalization was uncomplicated ARF. Post-hospital care was defined as the receipt of extended facility care or home health care following hospital discharge. Results: Nearly 50% of patients hospitalized with uncomplicated ARF required some type of post-hospital care, of whom 27% underwent extended facility care while 22% received home health care. The post-hospital care requirements for uncomplicated ARF were similar to those for serious medical conditions (e.g. heart failure) and exceeded those of many common illnesses (e.g., bronchitis). Advancing age, worsening severity of illness, female gender, and emergency room admission were independently associated with receipt of post-hospital care (p < 0.05). A trend existed between less frequent post-hospital care requirements and hospitalization at academic medical centers compared with non-academic hospitals. Conclusions: Uncomplicated ARF is frequently associated with prolonged care following hospitalization. As the health care utilization for ARF becomes better characterized, these post-hospital care resources should not be overlooked.

Acute Kidney Injury Predicts Outcomes of Non-Critically Ill Patients

“…1,[8][9][10][11][14][15][16][17] Fewer studies have reported the epidemiology of renal dysfunction in non-ICU patients. [18][19][20][21][22][23] Liangos et al 21 used the 2001 National Hospital Discharge Survey to demonstrate that 1.9% of hospitalized patients were diagnosed as having acute renal failure. Acute renal failure was assumed to be present if it was mentioned in the discharge summary and independently predicted hospital mortality and prolonged LOS.…”

Envolvimento da Heme oxigenase-1 nos mecanismos celulares de resposta ao estresse em um modelo de lesão renal aguda.

“…Most CKD basic studies are performed with experimental models, such as the remnant model, also termed 5/6 nephrectomy (Nx), which was originally described by Shimamura and Morrison [3]. The progression of renal disease in the remnant model is characterized by the development of glomerulosclerosis and interstitial fibrosis [4,5]. The reduction of nephron mass leads to hypertrophy, hyperfiltration, glomerular and systemic hypertension, and thus, glomerulosclerosis [6].…”

“…Activation of TLRs induces a proinflammatory cascade, with downstream participation of NF-kB target genes [5]. Furthermore, the activation of intracellular sensors such as NOD-like receptors, for example, NLRP3, leads to the formation of the inflammasome complex by converting procaspase-1 into active caspase-1, which in turn results in secretion of IL-1b, IL-18 and IL-33 [6].…”

“…Malariaassociated acute kidney injury (AKI), one of the three major lifethreatening well-know causes of death in P. falciparum [1,2] and P. vivax severe malaria [3,4], occurs between 1-4% of hospitalized adult [5] with a mortality that can reach up to 45% [1]. The pathogenesis of malaria-associated AKI is multifactorial and not well characterized, but several hypotheses suggest involvement of cytoadherence of iRBC, proinflammatory response as well as nephrotoxicity due to oxidative stress.…”

“…Por exemplo, tais pacientes possuem maior dificuldade em serem retirados da ventilação mecânica [3] e são mais propensos a edema, com subsequente elevação da mortalidade e comprometimento da recuperação renal [4]. Além disso, quando os pacientes deixam o hospital, eles geralmente levam mais tempo para se recuperarem, além de em muitos casos necessitarem de ajuda profissional especializada e muitas vezes não terem a função renal completamente restabelecida [5].…”