Why the Persistently High Mortality in Acute Renal Failure ?

Stott, R.B.; Ogg, C S; Cameron, J. S.; Bewick, M.

doi:10.1016/s0140-6736(72)91562-0

Cited by 163 publications

(56 citation statements)

References 11 publications

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“…The outcome in children with ARF largely depends on the primary cause of ARF [17]. Published data suggested a recovery rate of about 70% and 30% mortality [18].…”

Section: Discussionmentioning

confidence: 99%

Etiology, Presentation and Mangement of Acute Renal Failure in Saudi Children

et al. 1992

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One hundred children with acute renal failure (ARF) were admitted in our Nephrology Unit, Maternity & Children's Hospital over a four year period. Male patients outnumbered females with a ratio of 3:2. The ages of patients ranged from 1 month to 13 years with a mean age of 3.9 years. Fifty-five were suffering from intrinsic renal factors, 32 from post-renal and 13 were due to pre-renal factors. Among the intrinsic renal causes: acute glomerulonephritis (27 patients) and hemolytic-uremic syndrome (15 patients) were most common. Posterior urethral valve (20 patients) was the leading cause of post-renal failure. All pre-renal failure was due to diarrheal disease. Forty patients with ARF required dialysis (23 peritoneal dialysis, 17 hemodialysis). The remaining 60 patients were treated conservatively. The outcome in our patients were as follows: 60% cured, 29% continued to have variable degrees of renal failure and only 11% died. The latter was due to sepsis and cardiorespiratory failure. Acute renal failure (ARF) is not uncommon in children. The incidence varies from 4-22 per million population [1]. Intrinsic renal failure is the leading cause of ARF in developed countries [2], whereas pre-renal failure due to renal hypoperfusion is the leading cause of ARF in developing countries [3]. Post-renal failure occurs usually due to obstructive uropathy reported in 2% to 15% of children with ARF [4].No data are available from the Kingdom of Saudi Arabia regarding children presenting with ARF. We conducted this study in order to analyze the etiological factors, clinical presentation, response to the different modes of treatment and the outcome in 100 children admitted to our renal unit with this condition. Methods and MaterialsThe study included 100 children with ARF referred to our unit from different parts of the Kingdom over a period of four years. Children less than one-month-old were excluded from the study as the pattern of disease is different at this age.Acute renal failure was defined as a reduction in glomerular filtration rate "GFR" as manifested by oliguria (urine volume less than 300 ml/M2/day) or anuria (urine volume less than 1 ml/kg/day) and niore than 50% decrease in renal function as measured by serum creatinine (i.e. > 160 μmοΙ/L). Patients with normal urine output and increasing blood urea and serum creatinine were defined as having non-oliguric renal failure and included in this study [5].Pre-renal failure was diagnosed if the urine osmolality was more than 500 mosmol/L, urine urea to plasma urea concentration ratio more than five, fractional excretion of sodium "FeNa" less than 1% [6]. In cases we doubted a fluid challenge of 20 ml/kg of dextrose saline was given in order to differentiate between pre-renal and intrinsic renal failure. Initial diagnosis of post-renal failure was made by renal ultrasonography which was done routinely on all cases. Other investigations done at different stages of illness include renal isotope scan, micturating cystogram and transurethral endoscopy. Renal biopsy was done ...

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“…The outcome in children with ARF largely depends on the primary cause of ARF [17]. Published data suggested a recovery rate of about 70% and 30% mortality [18].…”

Section: Discussionmentioning

confidence: 99%

Etiology, Presentation and Mangement of Acute Renal Failure in Saudi Children

et al. 1992

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“…Despite the introduction of modern dialysis techniques, a poor prognosis and high risk of mortality still accompany acute renal failure (ARF)' after ischemia or surgical trauma (1). So far no single pharmacological intervention has been shown to reliably prevent the maintained loss of renal function after these events.…”

Section: Introductionmentioning

confidence: 99%

Atrial natriuretic peptide protects against acute ischemic renal failure in the rat.

Shaw¹,

Weidmann²,

Hodler³

et al. 1987

J. Clin. Invest.

136

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Because of its ability to increase glomerular filtration, antagonize the actions of vasoconstrictors, and produce vasodilatation, alpha human atrial natriuretic peptide (a-hANP) was evaluated for its potentially beneficial effects in experimental ischemic renal failure induced by 45-60 min of renal artery occlusion in bilaterally or unilaterally renally intact SpragueDawley rats. After ischemia, a 4-h intrarenal infusion of ahANP restored 14C-inulin clearances in bilaterally and unilaterally intact animals from 0.05±0.006 and 0.05±0.01 ml/ min per 100 g to 0.314±0.04 and 0.25±0.01 ml/min per 100 g, respectively (P < 0.001, n = 8), compared with normal values of 0.49±0.023 ml/min per 100 g. Histologically, there was a progressive decrease in medullary hyperemia and prevention of intratubular cell shedding and granulocyte margination as a result of the 4-h a-hANP infusion such that after 24 and 48 h the histological appearance of the tissue was essentially normal. The results show that a 4-h intrarenal infusion of a-hANP after renal ischemia can preserve glomerular filtration rate and reduce renal tissue damage.

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“…Enquanto alguns estudos mostraram que o paciente idoso com IRA apresentava maior risco do que jovens portadores de disfunção renal aguda [24][25][26] , outros autores não conseguiram mostrar tal relação [27][28][29] , e que esta possível mortalidade mais elevada estava condicionada a uma alta incidência de complicações clínicas existentes previamente à instalação da IRA 29 . Entretanto, chama a atenção que poucos trabalhos se concentraram neste assunto, havendo discordância nos resultados, até porque alguns consideraram como idade mínima 60 anos 30 enquanto outros estudaram pacientes com 70 anos, ou mais 26 . Em nosso estudo retrospectivo com 130 pacientes com idade acima de 70 anos e portadores de IRA não encontramos dependência da idade com a sobrevida dos doentes.…”

Section: Causas Deunclassified

Causas e prognóstico da insuficiência renal aguda hospitalar em pacientes idosos

Junior¹,

Haiashi²,

Júnior³

et al. 2000

Rev. Assoc. Med. Bras.

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RESUMO -OBJETIVOS. O objetivo deste estudo foiO aumento da expectativa de vida da população é uma razão óbvia para explicar o aumento da proporção de pacientes idosos admitidos em uma instituição terciária 1-3 . Ao mesmo tempo, observase uma maior incidência de insuficiência renal aguda (IRA) na população com idade mais elevada 4,5 , e três fatores afetando a hemodinâmica renal têm sido imputados para esta maior incidência: o próprio processo de envelhecimento renal, a maior freqüência de estados patológicos nesta faixa etária, o uso excessivo de medicamentos por estes pacientes e o, cada vez mais freqüente uso de procedimentos intervencionista e cirúrgicos neste grupo específico de doentes 4-6 . Além disso, o relatado aumento da faixa etária dos portadores de IRA poderia ser também um dos responsáveis pela mudança do perfil destes pacientes demonstrada em trabalhos mais recentes 7,8 .Poucos são os estudos analisando as caracterís-ticas evolutivas da IRA em pacientes idosos, especialmente os casos de IRA em um hospital emi-

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Why the Persistently High Mortality in Acute Renal Failure ?

Cited by 163 publications

References 11 publications

Etiology, Presentation and Mangement of Acute Renal Failure in Saudi Children

Etiology, Presentation and Mangement of Acute Renal Failure in Saudi Children

Atrial natriuretic peptide protects against acute ischemic renal failure in the rat.

Causas e prognóstico da insuficiência renal aguda hospitalar em pacientes idosos

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