PubMed1971
The results are reported of the incidence, severity, and description of infectious complications in 646 cases of acute renal failure (ARF). Infection was felt to represent an important cause of ARF in 34% of the cases. However, the frequency and extent of the infection varied according to the biologic classification. It was present constantly in postabortion ARF, was frequent in medical and in postoperative ARF, and was rare in traumatic and postpartum ARF. The renal lesions vary according to the cause of the infections. Staphylococcus septicemia, leptospiral infections, and rickettsial infections are the causes of interstitial nephritis; whereas gram-negative septicemia, probably via infectious shock, leads more readily to tubular lesions. Hemolytic septicemias most often cause tubular necrosis, although this is usually reversible. When the initial clinical picture is complicated by disseminated intravascular coagulopathy, bilateral cortical necrosis is a distinct possibility. During the established phase of ARF, infections are equally frequent, whether primary or secondary. The most frequent complications are septicemia and bacteremia--or local complications, most often pulmonary or urinary tract infections. The organisms are mainly Staphylococcus (often mephicillin-resistant) and gram-negative, usually E. coli. The most effective treatment is a combination of cephalothin and gentamicin. Pseudomonas infections are the most difficult to treat. The frequency of these serious infections and the difficulty with antibiotic therapy, often dangerous in renal insufficiency, stress the importance of preventive treatment of prophylactic measures. Infection was primarily responsible for 19% of the deaths in our series and may be also largely responsible for some of the persistent residual renal functional impairments.