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PubMed1996

Plasma quinine concentrations in falciparum malaria with acute renal failure.

Plasma quinine (Qn) monitoring was performed in 32 patients with severe falciparum malaria (10 with acute renal failure (ARF) and 22 with other severe manifestations) who were treated with the standard regimen of 10 mg/kg body weight Qn dihydrochloride, with a loading dose of 20 mg/kg body weight. Median plasma Qn concentrations prior to the first dose on each day were approximately 10-30% higher in ARF patients than in non-ARF patients during acute infection. Seven patients underwent haemodialysis; 2 died after 2 cycles. There were no significant changes in plasma Qn concentrations in patients with ARF during haemodialysis. No Qn was detectable in haemodialysate fluids. This suggests that dosage adjustment of Qn during haemodialysis is unnecessary. Cardiotoxity of Qn must be of concern in malaria patients with ARF after 3 days of Qn therapy, and ECG monitoring during Qn infusion is recommended in all severe malaria patients with persistent ARF. If there is any arrhythmia, the infusion should be discontinued. However, in some hospitals where ECG facilities are not available, reduction in Qn dosage in persistent ARF patients should be considered after the third day of therapy. The appropriate dosage reduction should be further studied. Monitoring of total plasma Qn concentrations (which has been used routinely) is of no value for predicting the cardiotoxicity in ARF patients; monitoring of free Qn would be more appropriate. However, ECG seems to be the practical procedure to monitor cardiotoxicity of Qn. It may be possible to use the QTc interval to estimate the Qn concentration in severe malaria patients without ARF, but not in patients with persistent ARF.

Acute Kidney Injury↗
PubMed2005

Prognostic value, kinetics and effect of CVVHDF on serum of the myoglobin and creatine kinase in critically ill patients with rhabdomyolysis.

BACKGROUND: (I) To investigate the kinetics of the myoglobin and creatine kinase (CK) in rhabdomyolysis. Especially to describe those patients in whom an isolated increase in the myoglobin or the CK occurred at a later stage. (II) To evaluate the sensitivity of the myoglobin and the CK as prognostic tools for the development of Acute renal failure (ARF). (III) To investigate the effect of continuous venovenous haemodiafiltration (CVVHDF) on the myoglobin elimination in ARF. PATIENTS AND METHODS: Prospective and retrospective cohort study carried out in an ICU of a university hospital. A total of 47 critically ill patients with rhabdomyolysis and a plasma myoglobin > 5000 microg l(-1) were admitted between July 1998 and July 2003. RESULTS: (I) The myoglobin peaked 0.66 +/- 0.6 days before the CK. The elimination kinetics of the myoglobin was faster than for the CK. (II) Fifty percent developed ARF. Mortality in the ARF patients was 52% compared to 14% in the non-ARF patients. The sensitivity and specificity of developing ARF were higher with the myoglobin in comparison to the CK. (III) In non-ARF, t(1/2) CK was 25.5 h and t(1/2) myoglobin was 17 h (13-23). In those with ARF treated with CVVHDF, t(1/2) CK was 24.8 and t(1/2) myoglobin was 21 h (17-29). CONCLUSION: (I) The myoglobin peaked earlier than the CK. (II) The myoglobin was a better prognostic tool than the CK. However, the myoglobin also has a wide interindividual range. (III) Though the myoglobin is eliminated in ultrafiltration t(1/2) myoglobin, it was not faster in patients with ARF treated with CVVHDF compared to non-ARF patients.

Acute Kidney Injury↗
PubMed2005

The epidemiology of acute rheumatic fever in Indigenous people in north Queensland.

OBJECTIVE: To describe the epidemiology and features of acute rheumatic fever (ARF) in Indigenous people in north Queensland from mid-1999 to mid-2004. METHODS: Enhanced surveillance, including regular reminder letters to relevant clinicians and computer searches of hospital discharge diagnoses, was implemented to capture cases of ARF. RESULTS: Over the five years, 144 episodes of ARF occurred in 133 Indigenous people in seven of the Health Service Districts in north Queensland. The annual incidences of ARF were 61 cases/100,000 Indigenous people in these seven districts, and 54/100,000 throughout north Queensland. The median age of the cases was 12.0 years, and 76% of the cases occurred in children <15 years. More than one-third of the definite cases were recurrences of ARF, and carditis was present in 42% of all cases. CONCLUSIONS: Within north Queensland, the incidences of ARF were greatest in the Cape York and the Torres Strait and Northern Peninsula Area Districts. However, the incidence of ARF in north Queensland is considerably lower than that reported from the Top End of the Northern Territory (NT). Furthermore, there appears to be less chorea and less monoarthritis, but more group A streptococci isolated from throat swabs, in ARF cases in north Queensland compared with those from the Top End of the NT. IMPLICATIONS: There is a need for greater awareness of ARF and its complications among both ARF patients and primary health care workers in the region, and for more reliable mechanisms for recalling patients for their prophylaxis and clinical reviews.

Acute Disease↗
PubMed2004

Pediatric acute renal failure in southwestern Nigeria.

BACKGROUND: Acute renal failure (ARF) was investigated to determine the prevalence of ARF clinical types, etiology, comorbidities, and outcome in Nigerian children. METHODS: Consecutive cases of ARF admitted from March, 1994 through February, 2003 were prospectively studied. Information were obtained concerning the following: age, gender, body surface area, early (within 48 hours of onset of ARF) or late (>48 hours of onset of ARF) presentation, admission duration, etiology, comorbidities, urine volume/day, dialysis need, reasons for considering dialysis, laboratory investigations, and outcome in each patient. Histopathologic reports of percutaneous renal and surgical biopsies, as well as autopsy specimens, were reviewed. RESULTS: There were 78 boys and 45 girls (M:F, 1.73:1); mean age was 6.28 +/- 4.0 years. A portion of patients presented early (46.3%), while 53.7% presented late. Oliguric (63.41%), anuric (20.33%), and nonoliguric (16.26%) ARF were the clinical types seen. Dialysis requirement was significantly higher in oliguric (P < 0.005) and anuric (P < 0.005) than nonoliguric ARF. Primary and secondary etiologies accounted for 29% and 71% of ARF cases, respectively. Renal Burkitt's lymphoma (47.2%), glomerulonephritis (27.8%), nephrotic syndrome (16.7%), hemolytic uremic syndrome (5.5%), and acute tubulointerstitial nephritis (2.8%) were primary etiologies. Plasmodium falciparum malaria (42.53%), septicemia (28.73%), hypovolemia (11.49%), and obstructive uropathy (8.05%) were major secondary etiologies. Financial constraints on the part of parents of patients, as well as inadequate and/or lack of dialysis equipment, were major inhibitions to effective management of the patients; in fact, 6 patients took voluntary discharge due to inability to afford the cost of treatment. Mortality risk factors were late presentation [odds ratio (OR) 3.5, P < 0.001], dialysis eligibility (OR 3.8, P < 0.001), nondialysis (OR 23.1, P= 0.00004), primary etiology (OR 2.6, P < 0.025), and presence of > or =2 comorbidities (OR 2.9, P < 0.025); overall mortality rate was 46.2%. CONCLUSION: These results show that many of the causes of ARF in our patients are preventable; it should be possible to reduce morbidity due to ARF through purposive preventive measures.

Acute Kidney Injury↗
PubMed2002

Early management and prevention of acute renal failure.

Despite major advances in nutritional support, membrane technology and dialytic techniques, the mortality of patients with acute renal failure (ARF) who require dialysis is still almost 50% (1). Increased patient age and co-morbidity confer a poorer prognosis, and the condition is certainly commoner in this patient group. Hence, one study showed that the age-related annual incidence of ARF increased from 17 per million in adults under 50 years to 949 per million in the 80-89 age group (2). Over 60% of cases of ARF ultimately result from renal hypoperfusion and consequent intra-renal ischaemic damage, which leads to acute tubular necrosis (ATN) (3). Ischaemic ARF may thus result from a diversity of systemic and intra-renal circulatory stresses including acute losses of blood and extra-cellular fluids, from low cardiac output states such as following ischaemic or toxic myocardial damage, and even from drug-induced renal perfusion shutdown (ACE inhibitors, non-steroidal anti-inflammatory agents). Many cases of ARF have a multi-factorial aetiology (e.g. post-surgical sepsis with hypovolaemia, hypotension and injudicious antibiotic use), and these patients, who often have other organ failure, fit into the poorer prognostic category. A large number of patients with ischaemic ARF pass through a phase of potentially reversible pre-renal oliguria; early recognition and prompt, appropriate treatment of these pre-renal factors can prevent progression to established ARF, with the genuine prospect of improved patient morbidity and mortality, and this is the main scope of this article. Early diagnosis in other patients with ARF, such as those with acute inflammatory renal disease (e.g. vasculitis) or urinary tract obstruction, will allow appropriate prompt treatment and the possibility for reversal of the ARF. The following account, which is composed of personal experience, that of colleagues, and the literature (1,4), is not intended to provide a comprehensive guide to the management of ARF, but seeks to highlight important common pitfalls and fundamental principles in the recognition and subsequent preventive treatment of these patients.

Acute Kidney Injury↗
PubMed2005

Enhanced skeletal muscle arteriolar reactivity to ANG II after recovery from ischemic acute renal failure.

In addition to the long-term renal complications, previous studies suggested that after acute renal failure (ARF), rats manifest an increased pressor response to an overnight infusion of ANG II. The present study tested whether recovery from ARF results in alterations in sensitivity to the peripheral vasculature. ARF was induced in Sprague-Dawley rats by 45 min of bilateral renal ischemia and reperfusion. Animals were allowed to recover renal structure and function for 5-8 wk, after which the acute pressor responses to ANG II were evaluated either in vivo in in situ skeletal muscle arterioles or in isolated gracilis muscle arteries in vitro. Baseline arterial pressure was not different in ARF rats vs. sham-operated controls, although ARF rats exhibited an enhanced pressor response to bolus ANG II infusion compared with control rats. Steady-state plasma ANG II concentration and plasma renin activity were similar between ARF and control rats. Constrictor reactivity of in situ cremasteric arterioles from ARF rats was enhanced in response to increasing concentrations of ANG II; however, no difference was observed in arteriolar responses to elevated PO2, norepinephrine, acetylcholine, or sodium nitroprusside. Isolated gracilis muscle arteries from ARF rats also showed increased vasoconstriction in response to ANG II but not norepinephrine. In conclusion, recovery from ischemic ARF is not associated with hypertension but is associated with increased arteriolar constrictor reactivity to ANG II. Although the mechanisms of this altered responsiveness are unclear, such changes may relate, in part, to cardiovascular complications in patients with ARF and/or after renal transplant.

Acute Kidney Injury↗
PubMed1996

Insulin-like growth factor-I action on glucose transport in acute renal failure.

Insulin resistance is common in acute renal failure (ARF). Insulin-like growth factor (IGF)-I has insulin-like actions. The present study was undertaken to determine whether effects of IGF-I on glucose transport are maintained in rats with ARF and to compare these actions of IGF-I with those of insulin. ARF was induced in male Sprague-Dawley rats by bilateral ureteric ligation, and vascular catheters were inserted at the same time in all animals. Sham-operated controls were pair fed, and metabolic studies were performed 48 h later. ARF rats had higher serum creatinine (1.3 +/- 0.2 mg/dl vs. 0.3 +/- 0.1), lower arterial pH (7.15 +/- 0.03 vs. 7.35 +/- 0.02), and higher fasting serum glucose (150 +/- 13 vs. 123 +/- 12 mg/dl) compared with control rats (P < 0.001 in all cases). The hypoglycemic effects of insulin and IGF-I were compared using euglycemic clamps. In control rats, rates of total body glucose uptake were not different during euglycemic insulin clamps at 2 mU.kg-1.min-1 and euglycemic IGF-I clamps at 5 micrograms.kg-1.min-1. In rats with ARF, total body glucose uptake during euglycemic insulin clamps at 2 mU.kg-1.min-1 was significantly reduced (6.5 +/- 0.5 mg.kg-1.min-1) compared with controls (10.5 +/- 1.5 mg.kg-1.min-1, P < 0.01). In contrast, total body glucose uptake during euglycemic IGF-I clamps at 5 micrograms.kg-1.min-1 in ARF rats (10.1 +/- 1.2 mg.kg-1.min-1) was not different from the corresponding value in control animals (10.3 +/- 1.3 mg.kg-1.min-1). Hepatic glucose production was suppressed by insulin equally but not suppressed by IGF-I in both groups. In a second experiment, ARF was induced by bilateral renal ischemia. The following groups of animals were studied: ARF + NaCl, ARF + NaHCO3, and control + NaCl. Insulin and IGF-I clamps were performed as above. Correction of acidosis partially corrected insulin resistance but did not affect IGF-I sensitivity. Thus the capacity of IGF-I infusion to stimulate glucose uptake is maintained in ARF rats, which are insulin resistant.

Acute Kidney Injury↗
PubMedDate not supplied

Impact of burn size and initial serum albumin level on acute renal failure occurring in major burn.

BACKGROUND: Acute renal failure (ARF) is not a rare occurrence in severe burns and is an important complication leading to an increase in mortality. The severity of the burn is largely determined by the burn size, and severe burns are likely to cause enough loss of extracellular fluid and albumin from plasma volume to produce shock and hypoalbuminemia. HYPOTHESIS: We hypothesized that initial serum albumin level may be useful as an indicator of prognosis and severity of injury in burned patients. METHODS: The clinical characteristics of 147 adult patients with second- and third-degree burns covering 30% or more of their body surface area were analyzed retrospectively. Logistic regression was used to estimate the relative risks of ARF and mortality associated with the larger burn size and the lower serum albumin level at admission. RESULTS: Mean burned body surface was 60.0 +/- 21.8% (range 30-100%). Twenty-eight (19.0%) out of 147 patients experienced ARF, defined as a serum creatinine > or = 2 mg/dl, during the admission. The patients with ARF had larger burn size (79.5 +/- 15.4 vs. 55.3 +/- 20.5%, p < 0.0001) and lower serum albumin concentration at admission (1.92 +/- 0.66 vs. 2.48 +/- 0.82 g/dl, p < 0.0005) compared with those without ARF. All patients with ARF expired, whereas 29.4% (35/119) of the patients without ARF died. The burn size > or = 65% was associated with a risk of ARF that was 9.9 times and with a risk of death that was 14.2 times as high as that for the burn size <65%. The initial serum albumin level <2.5 g/dl was associated with a risk of death that was 2.7 times as high as that for the initial serum albumin level > or = 2.5 g/dl. CONCLUSIONS: When major burns are complicated by ARF, the mortality rate increases significantly. Burn size is an independent predictor of ARF occurring in major burns. Initially depressed serum albumin level is associated with an increase in mortality in the major burn patients.

Acute Kidney Injury↗
PubMed1995

Incidence, severity, and mortality of acute respiratory failure in Berlin, Germany.

A prospective multicenter study was carried out from October 1 to November 30, 1991, to determine the incidence, severity, and mortality of acute respiratory failure (ARF) in Berlin, Germany, a metropolis with a population of 3.44 million. Adult patients from 72 intensive care units (ICUs) were evaluated. ARF was defined as: (1) intubation and mechanical ventilation (I+MV) > or = 24 h; age > or = 14 yr. Incidence of ARF was assessed as the number of patients fulfilling ARF criteria within the 2-mo study period. Severity of ARF was defined as "no lung injury" (NLI), "mild-to-moderate lung injury" (MMLI), and "severe lung injury" (SLI) according to Murray and coworkers' proposals. Mortality was assessed as number of patients with ARF dying during ICU stay. During the study period, 508 patients were diagnosed as having ARF, representing an incidence of ARF of 88.6 per 100,000/yr. Twenty-four h after I+MV, MMLI occurred in 94% and SLI in 3.6% of the ARF patients. Overall mortality rate was 42.7%. Mortality rate in the NLI group was 36.4%; in patients with MMLI, 40.8%; and in patients with SLI, 58.8%. Our data offer novel information on incidence, severity, and mortality of ARF in a major urban population.

Adult↗
PubMedDate not supplied

The nutrition management of the patient with acute renal failure.

The clinical status of patients with acute renal failure (ARF) varies greatly. Some individuals have only mild or moderate ARF or may have only mild perturbations of their metabolic status. Other patients exhibit a severe reduction in renal function with oliguria or anuria. Depending upon their comorbid conditions, ARF patients may be among the most hypercatabolic patients in the hospital. Clinical trials have not clearly shown a beneficial effect of nutrition support on morbidity or mortality in patients with ARF, although limitations in sample size and experimental design and inclusion of patients with widely disparate clinical conditions may have contributed to the difficulty in demonstrating benefits. Several recent therapeutic approaches that have been studied either in experimental animals with ARF or in small numbers of humans with ARF hold promise for improving clinical outcome. Continuous arteriovenous or venovenous hemofiltration with or without dialysis is such a therapy. In comparison to intermittent hemodialysis this former treatment more safely removes large quantities of water and solutes from critically ill patients with unstable hemodynamics and allows them to receive rather large quantities of nutrients, including amino acids. Also promising are studies in experimental animals with ARF which indicate that several growth factors may accelerate the recovery of renal function. In rats with ARF, insulin-like growth factor 1 both enhances recovery of renal function and suppresses their enhanced catabolism. For most patients with ARF requiring nutrition support, evidence suggests that both essential and nonessential amino acids should be employed. However, there appears to be a therapeutic role for small quantities of essential amino acids, without nonessential amino acids, in selected patients. Data support the importance of proactive measures to prevent fluid and electrolyte imbalances in patients with ARF.

Acute Kidney Injury↗
PubMed2003

Outcome after acute respiratory failure is more dependent on dysfunction in other vital organs than on the severity of the respiratory failure.

INTRODUCTION: The incidence and outcome of acute respiratory failure (ARF) depend on dysfunction in other organs. As a result, reported mortality in patients with ARF is derived from a mixed group of patients with different degrees of multiorgan failure. The main goal of the present study was to investigate patient outcome in single organ ARF. PATIENTS AND METHOD: From 1 January 2000 to 1 July 2002, all adult patients (>16 years) in the intensive care unit (ICU) at Haukeland University Hospital were scored daily using the Sequential Organ Failure Assessment (SOFA) score for organ failure. ARF was defined by the SOFA criteria: ratio of arterial oxygen tension to fractional inspired oxygen, with a value < 26.6 kPa (200 mmHg) in more than one recording during the ICU stay (SOFA score 3 or 4). Patients with ARF alone and in combination with other severe organ failure (SOFA score 3 or 4) were included. Survival was recorded on discharge from the ICU, at hospital discharge and at 90 days after ICU discharge. RESULTS: During the period of study, 832 adult patients were treated and 529 (63.0%) had ARF. The ICU, hospital and 3-month mortality rates were lowest in single organ ARF (3.2, 14.7 and 21.8%, respectively), with increasing mortality with each additional organ failure. When ARF occurred with four or five additional organ failures, the 3-month mortality rate was 75%. No significant differences in mortality were found between early and late ARF. CONCLUSION: The prognosis for ICU patients with single organ ARF is good, both in the short and long terms. The high overall mortality rate observed is caused by dysfunction in other organs.

Adult↗
PubMed2003

Association between heat shock protein 72 gene polymorphism and acute renal failure in premature neonates.

Heat shock protein (HSP)70 plays an important role in the ischemic tolerance of fetal and neonatal kidney. We have investigated the association of genetic polymorphisms of the constitutive HSP70 (HSP73) and the inducible HSP70 (HSP72) encoding genes with the risk of acute renal failure (ARF) in very low birth weight (VLBW) neonates. Thirty-seven VLBW neonates with ARF and 93 VLBW neonates without ARF were enrolled in the study. The presence of HSP72 (1267)AG and HSP73 (190)GC polymorphism was analyzed from dried blood samples by PCR and restriction length fragment polymorphism. Allelic prevalence was related to reference values obtained in 131 healthy adults. Stepwise binary logistic regression was applied to determine the independent effect of the established risk factors to the development of ARF. Sixteen of 37 VLBW neonates with ARF and 18 of 93 VLBW neonates without ARF were homozygous for HSP72 (1267)G allele (p </= 0.01). The association between HSP72 (1267)GG genotype and ARF remained at the level of significance (p = 0.05) when it was adjusted for established risk factors of neonatal ARF. Prevalence of HSP72 (1267)GG was also higher in VLBW neonates than in the reference population (p < 0.05) and in VLBW neonates with infant respiratory distress syndrome than in those without (p < 0.001). We found that in VLBW neonates carrying HSP72 (1267)GG genetic variation, which is associated with low inducibility of HSP72, the risk of ARF was increased. Therefore, VLBW neonates with (1267)GG might express less HSP72 and might be less protected against ARF.

Acute Kidney Injury↗
PubMed1986

Hypocalcemia and hypercalcemia in patients with rhabdomyolysis with and without acute renal failure.

Patients with rhabdomyolysis (RBD) and acute renal failure (ARF) are hypocalcemic during the oliguric phase of ARF and over 30% develop hypercalcemia during the diuretic phase. The present study examined the factors underlying these derangements in calcium metabolism in 15 patients: 7 with RBD and ARF, 4 with RBD only, and 4 with ARF only. All patients had hypocalcemia on admission and the hypocalcemia was more pronounced in those with RBD and ARF. All patients with RBD independent of the presence or absence of ARF had calcium deposition in soft tissues as documented by technetium-99 scan. In 4 patients with RBD and ARF, hypercalcemia developed during the diuretic phase at a time when Serum PTH levels were undetectable. Only patients with RBD and ARF had a significant increase in serum levels of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D [1,25(OH)2D] during the diuretic phase and both the increments in and the levels of 1,25(OH)2D were significantly greater in those who were hypercalcemic. The data indicate that 1) hypocalcemia occurs in RBD independent of ARF and is most likely related to calcium deposition in injured tissues, and 2) elevation in serum levels of 1,25(OH)2D plays an important role in the genesis of hypercalcemia during the diuretic phase of patients with RBD and ARF. Our observations suggest that extrarenal production of 1,25(OH)2D may occur in these patients, and/or that the renal production of 1,25(OH)2D may not be so tightly controlled as it is in normal subjects.

Acute Kidney Injury↗
PubMed1985

Influence of acute renal failure on pharmacokinetics of phenolsulfonphthalein in rats: a comparative study in vivo and in the simultaneous perfusion system of liver and kidney.

The effect of acute renal failure (ARF) on the disposition of phenolsulfonphthalein (PSP) after intravenous administration was investigated in rats. ARF was induced by the subcutaneous injection of uranyl nitrate to rats. Renal excretion of PSP decreased significantly in ARF compared to that in normal controls. On the other hand, rats with ARF showed an increased biliary excretion of PSP to compensate for reduced renal excretion of the drug. Consequently no significant change was found in total body clearance of PSP between control and ARF. The in vitro binding experiment showed that the binding fraction of PSP to ARF plasma was significantly lower than that to control plasma. In order to clarify the regulatory mechanisms of PSP excretion between liver and kidney in ARF, we developed a simultaneous perfusion system of rat liver and kidney, which could control the flow rate and the constituent of the perfusate. In this perfusion system, neither biliary excretion nor the protein binding of PSP differed significantly between control and ARF, though its renal excretion decreased in ARF in a similar manner as in vivo. These results suggest that alterations in plasma protein binding as well as renal excretory function are determinants of PSP disposition in ARF.

Acute Kidney Injury↗
PubMed2004

p19Arf suppresses growth, progression, and metastasis of Hras-driven carcinomas through p53-dependent and -independent pathways.

Ectopic expression of oncogenes such as Ras induces expression of p19(Arf), which, in turn, activates p53 and growth arrest. Here, we used a multistage model of squamous cell carcinoma development to investigate the functional interactions between Ras, p19(Arf), and p53 during tumor progression in the mouse. Skin tumors were induced in wild-type, p19(Arf)-deficient, and p53-deficient mice using the DMBA/TPA two-step protocol. Activating mutations in Hras were detected in all papillomas and carcinomas examined, regardless of genotype. Relative to wild-type mice, the growth rate of papillomas was greater in p19(Arf)-deficient mice, and reduced in p53-deficient mice. Malignant conversion of papillomas to squamous cell carcinomas, as well as metastasis to lymph nodes and lungs, was markedly accelerated in both p19 (Arf)- and p53-deficient mice. Thus, p19(Arf) inhibits the growth rate of tumors in a p53-independent manner. Through its regulation of p53, p19(Arf) also suppresses malignant conversion and metastasis. p53 expression was upregulated in papillomas from wild-type but not p19( Arf)-null mice, and p53 mutations were more frequently seen in wild-type than in p19( Arf)-null carcinomas. This indicates that selection for p53 mutations is a direct result of signaling from the initiating oncogenic lesion, Hras, acting through p19(Arf).

9,10-Dimethyl-1,2-benzanthracene↗
PubMed2000

Outcome of acute renal failure associated with cardiac surgery in infants.

OBJECTIVE: To analyze the impact of acute renal failure (ARF) on the evolution of infants undergoing cardiac surgery. METHODS: We assessed 15 infants undergoing cardiac surgery who developed (ARF). Their demographic, clinical and surgical data, and evolution were analyzed. RESULTS: Their mean age was 4.4+/-4.0 months (8 days to 24 months). Twelve infants were males, and 4 patients already had ARF at surgery. The primary cause of ARF was immediate acute cardiac dysfunction in 10 infants, cardiac dysfunction associated with sepsis in 2 infants, and isolated sepsis in 3 infants. All children depended on mechanical ventilation during their postoperative period, 14 infants used vasoactive drugs, and 11 had an infectious process associated with ARF. Thirteen infants required dialytic treatment. Eleven infants developed oluguric ARF, and all had to undergo peritoneal dialysis; of the 4 patients with non-oliguric, 2 required dialysis, the main indication being hypervolemia. Of these 13 dialyzed infants, 4 died in the first 24 hours because of the severity of the underlying cardiac disease (mean urea level of 49+/-20 mg/dl). The mortality rate for the entire group was 60%, and it was higher among the patients with oliguria ARF (73% vs 25%, p<0. 001). The cause of death was acute cardiac dysfunction in 6 infants (early type-1 ARF) and sepsis in the 3 remaining infants (late type-2 ARF). CONCLUSION: The mortality rate of ARF associated with cardiac surgery in infants was hight, being higher among children with oliguria; peritoneal dialysis was indicated due to clinically uncontrolled hypervolemia and not to the uremic hypercatabolic state.

Acute Kidney Injury↗
PubMed1997

Acute renal failure in open heart surgery.

A case-control study was performed to establish possible risk factors for acute renal failure (ARF) and mortality in patients undergoing cardiac surgery. A consecutive series of 704 patients were included in the study. A randomized sample of 255 patients was taken to analyze risk factors for ARF and mortality. Incidence of acute renal failure was 3.8% (27/704). Low cardiac output (LCO) was observed in all patients who developed ARF and in 72/255 without ARF (p < 0.0005). When LCO was isolated, no difference was found between groups. Association to prolonged perfusion time and sepsis increased the probability of developing ARF: 5/27 versus 0/255, p < 0.001; and 9/27 versus 0/255, p < 0.001, respectively. Overall mortality was 7.2% (51/704). Significant difference was found between ARF (55.6%, 15/27) and non-ARF patients (5.4%, 36/704), p < 0.005. Neither age nor sex was associated to outcome. Nonsurvivor patients were more oliguric (11/15 vs. 0/12, p < 0.005), required dialysis more frequently (7/15 vs. 0/12, p < 0.005), and were complicated with sepsis more often (9/15 vs. 0/12, p < 0.005), compared to survivors. We concluded that ARF was an uncommon complication in this group of patients, but mortality rate was dramatically high. This study identified LCO associated to prolonged perfusion time and sepsis as risk factors for ARF. Severity of ARF (oliguric forms and dialysis requirement) and postoperative events (sepsis) were associated with mortality.

Acute Kidney Injury↗
PubMed2001

[Mechanical ventilation therapy for aged patients with severe acute left heart failure combined with respiratory failure].

OBJECTIVE: To sum up the clinical experience of mechanical ventilation in treatment of aged patients with severe left heart failure (ALVF) combined with acute respiratory failure (ARF). METHODS: A retrospective analysis was carried out of the pattern, improvement rate, mortality, and complication of medical ventilation applied on 102 aged patients (82.0 9.9 yrs) with severe ALVF and ARF in the past 10 years. The data of the patients with ARF type I (42 cases) and the data of the patients with ARF type II (60 cases) were compared. RESULTS: The route of mechanical ventilation in 102 patients (115 times) included administration of oxygen via nasal mask (18 times), nasal intubation (69 times) and oral intubation (29 times). The ventilation pattern included volume control (115 times), pressure control (25 times), CPAP (26 times), and PEEP (45 times). The improvement rates in the patients as a whole, group ARF-I, and group ARF-II were 60.8%, 69.0%, and 55.0% respectively (P < 0.05 between each two groups). The mortality rates in the patients as a whole, group ARF-I, and group ARF-II were 39.2%, 30.9%, and 45.0% respectively (P < 0.05). The complications ever found in all of the patients included arrhythmia (37.3%). Hypotension (35.3%), pulmonary infection (34.3%), bleeding of gastrointestinal tract (31.4%), acid0base unbalance (20.6), and pressure pneumothorax (2.9%). The clinical condition (severity, mortality, and complication rate) was more critical in group ARF-II than in group ARF-I. CONCLUSION: Mechanical ventilation is conducted with more difficulty and higher risk for aged patients with severe ALVF. However, while operated appropriately, it will be effective.

Acute Disease↗