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PubMedDate not supplied

Beneficial effect of intrarenal verapamil in human acute renal failure.

Cellular Ca2+ influx during the reperfusion period after an ischemic insult has been proposed to be a crucial pathogenetic factor in the development of experimental acute renal failure (ARF). The present study, therefore, examined the potential beneficial effect of intrarenal verapamil, a calcium entry blocking agent, on ARF in patients. Twelve patients were enrolled in the study. Six ARF patients (experimental group)--ARF caused by malaria (4 patients) and leptospirosis (2 patients)--had a catheter placed in their renal artery; verapamil was infused at 100 micrograms/min for 3 h and intravenous furosemide, 0.8 mg/kg/h x 24 h was also administered. Another six ARF patients (control group)--ARF caused by malaria (5 patients) and leptospirosis (1 patient)--were treated with intravenous furosemide alone. Baseline renal function was comparable in both groups; GFR (3.16 +/- 3.24 vs 0.7 +/- 1.5 mL/min, NS), serum creatinine (Scr), (9.1 +/- 2.1 vs 11.3 +/- 2.2 mg/dL, NS), and urine volume (V) (41.79 +/- 4.77 vs 34.54 +/- 13.52 mL/h, NS), were comparable in the experimental and control groups. Twenty-four hours posttreatment, the increment of GFR (9.66 +/- 4.25 vs 1.32 +/- 0.50 mL/min, P less than .02) and V (181.8 +/- 61.7 vs 79 +/- 18 mL/h, P less than .04), were significantly greater in the experimental group as compared to the control group. The course of ARF was also shorter in the experimental group (6.5 +/- 2.1 vs 13 +/- 1.1 days, P less than .05), who also required less dialysis. Thus, combination of a renal arterial infusion of verapamil and intravenous furosemide significantly improves the renal function in tropical ARF as compared to intravenous furosemide alone.

Acute Kidney Injury↗
PubMed1996

Is pregnancy-related acute renal failure a disappearing clinical entity?

The actual disappearance of pregnancy-related acute renal failure (PR-ARF) is a common "feeling" for nephrologists. The aim of this study was to exactly quantify this event by evaluating epidemiology and the extent of renal damage in PR-ARF. From 1958 to 1994, 84 cases of PR-ARF were observed (5.8% of total number of ARF needing dialysis). In four successive periods (1956-67, 1968-77, 1978-87, 1988-94), the incidence of PR-ARF fell from 43% to 0.5% with respect to the total number of ARF, and from 1/3000 to 1/18,000 with respect to the total number of pregnancies. Maternal mortality in the past was high (31%), but no cases of death in the last period were seen. Irreversible renal damage was recorded in 11.1% of PR-ARF, and, in particular, in 18.7% of cases of preeclampsia-eclampsia (PE-E). The worst maternal and renal prognosis occurred in PE-E that was complicated by abruptio placentae (AP). Neither disseminated intravascular coagulation (DIC), microangiopathic hemolytic anemia, nor prostacyclin imbalance were significantly related to the severity of renal damage. Heparin therapy did not modify DIC evolution and renal outcome and was aggravated by severe hemorragic complications. Support therapy with plasma infusion, antithrombin III, and antiplatelet agents seems to be helpful. In conclusion, PR-ARF has become a rare occurrence and, in our experience, no cases of death or irreversible renal damage were observed in the last 7 years. The most important reasons for this favorable evolution seem to be an improved medical care and more effective measures of careful prevention, mainly regarding tempestive delivery.

Abruptio Placentae↗
PubMed1996

Prognosis of patients with acute renal failure in the intensive-care unit: a tale of two eras.

OBJECTIVE: To determine whether any changes occurred in the complexity of illness or survival of Mayo intensive-care unit (ICU) patients with acute renal failure (ARF) who required hemodialysis between the 1977 through 1979 period and the 1991 and 1992 era. DESIGN: A retrospective comparison was done of 71 consecutive ICU patients with ARF during 1977 through 1979 and 71 similar consecutive patients from the 1991 and 1992 period. MATERIAL AND METHODS: Each patient was scored for the three components of the acute physiology and chronic health evaluation (APACHE) II system (acute physiology score, age, and preexisting chronic health problems). Patient gender, postoperative status, presence of diabetes mellitus, presence of chronic renal insufficiency, and factors contributing to ARF were recorded for each patient. Patient survival and renal function at time of hospital dismissal and 12 months after initiation of hemodialysis were determined. RESULTS: In comparison with patients in the earlier study period, those in the later study period had a signficantly improved rate of hospital survival (52% versus 32%) and 1-year survival (30% versus 21%). At 1 year, 96% and 78% of survivors in the earlier and later study groups, respectively, had recovery of renal function. The mean total APACHE II score was the same in both study periods, but patients in the later group were older and had more APACHE II points for chronic health problems. In the earlier and later study groups, patients with an APACHE II score of 21 or lower had a mortality rate of 36% and 11%, respectively, and survival among those with a score of 34 or greater was 0% and 15%, respectively. In 1991 and 1992, more patients had two or more factors contributing to the development of ARF, and intravenous administration of a contrast agent and preexisting cardiac prerenal compromise were more frequent causes of ARF than in 1977 through 1979. The occurrence of sepsis and preexisting lung disease were associated with a dismal prognosis in both study periods. In 1991 and 1992, survival was improved for patients with preexisting diabetes mellitus, postoperative status, and contrast-induced renal failure. CONCLUSION: The prognosis of ICU patients with ARF has improved in more recent years, despite the fact that patients are now older, have more preexisting chronic health conditions, and have an increasing number of conditions contributing to development of ARF. The APACHE II scoring system demonstrated utility for quantifying the complexity of illness in these patients, but several important shortcomings may limit its usefulness as a comparative or prognostic tool in patients with ARF.

APACHE↗
PubMed2002

Cytohesins and centaurins control subcellular trafficking of macromolecular signaling complexes: regulation by phosphoinositides and ADP-ribosylation factors.

The ADP-ribosylation factor family of small GTP-binding proteins are implicated in the regulation of vesicular transport and control of cytoskeletal and cell adhesion events. The phosphoinositide 3-kinase, phosphoinositide 4-P 5-kinase and phospholipase D signaling pathways are major regulators of ARF signaling cascades. Two families of ARF regulatory molecules, the cytohesin ARF-Guanine nucleotide Exchange Factors and the centaurin GTPase-Activating Proteins provide key targets for the action of these lipids signals. A critical feature of the regulation of ARF signaling is coordinated recruitment of exchange factors, ARFs and GAPs to appropriate subcellular locations. These complexes drive repetitive cycles of ARF activation and membrane association that underlie the processes of cell movement as well as endosomal uptake and intracellular redistribution of signaling molecules. Cytohesins and centaurins bind specifically to a variety of other signaling proteins and these interactions may provide routes for regulated recruitment to the sites of ARF activation. Through their ability to control endosomal trafficking/recycling of these supramolecular signaling complexes ARF and phospholipid signaling pathways may have consequences that reach as far as the regulation of gene transcription and control of cell fate.

ADP-Ribosylation Factors↗
PubMed2002

Exercise-induced acute renal failure with renal hypouricemia: a case report and a review of the literature.

A previously healthy 16-year-old boy developed acute renal failure following a track race at a local athletic meeting. Several hours after the run, he expressed pain in the loins with nausea and vomiting. After 3 sessions of hemodialysis, he was referred to our hospital. On admission, serum creatinine was elevated to 2.3 mg/dl without an increase in serum uric acid level. After recovery from acute renal failure (ARF), hypouricemia (0.7 mg/dl) became evident in the patient. One year later, he suffered from ARF after a track race with the highest creatinine levels of 1.1 mg/dl. In order to clarify the cause and prognosis of ARF with renal hypouricemia, we summarized the clinical features in 18 patients previously described and our patient. Serum uric acid levels after recovery from ARF were below 1.0 mg/dl in all patients. Renal biopsy in 9 patients showed acute tubular necrosis in 8 patients and uric acid nephropathy in 1. The short-term prognosis of these patients seemed good, although 5 patients needed to undergo hemodialysis in their ARF courses. However, the recurrence of ARF episodes occurred in 6 patients (31.6%) including our patient, indicating that prevention of ARF might be necessary in these patients. More information is required to establish guidance for prevention of ARF.

Acute Kidney Injury↗
PubMed2004

Predictive value of interleukins 6, 8 and 10, and low HLA-DR expression in acute renal failure.

AIMS: HLA-DR expression and plasma levels of pro- and anti-inflammatory cytokines (IL-6, IL-8 and IL-10) and their predictive value concerning survival of critically ill systemic inflammatory response syndrome (SIRS) patients with and without acute renal failure (ARF) were evaluated. MATERIAL: A total of 103 consecutive adult patients with SIRS from 2 university hospital intensive care units participated in the study. METHOD: Laboratory data for all patients were prospectively collected on the day of admission and 2 days thereafter. Patients with acute renal failure (ARF) and non-ARF patients were compared by Mann-Whitney U-test. Independent predictors of mortality were tested using forward stepwise logistic multiple regression analysis. The discriminative power of different variables was tested using receiver operating characteristic (ROC) curve analysis. RESULTS: ARF developed in 36 patients (35%). ARF patients showed significantly lower HLA-DR expression and higher plasma levels of IL-6, IL-8 and IL-10 than non-ARF patients. In ARF, moderate discriminative power in predicting survival was observed for day 2 IL-6 and IL-10 plasma levels (AUCs 0.703 and 0.749, respectively). CONCLUSIONS: We found no clinically significant discriminative power in predicting survival of ARF patients for monocyte HLA-DR expression or cytokine plasma levels. Therefore, our results do not support the use of HLA-DR expression or cytokine plasma levels for that purpose.

Acute Kidney Injury↗
PubMed2004

Evolution and predictive power of serum cystatin C in acute renal failure.

AIMS: The serum concentration of cystatin C has recently been proposed as a better indicator of glomerular filtration rate (GFR) than plasma creatinine. Little is known about cystatin C in critical illness. We assessed serum cystatin C as a marker of renal function in acute renal failure (ARF) and its power in predicting survival of ARF patients. MATERIAL: 202 consecutive adult patients admitted into the intensive care unit (ICU) during a period of 9 months. METHOD: Serum cystatin C, plasma creatinine and plasma urea were measured on admission, daily during the first 3 days, and 5-7 times a week during the rest of the ICU stay. The patients with and without ARF were compared by the Mann-Whitney U-test. The correlation between different variables was calculated by Spearman's correlation. Forward stepwise multiple regression analysis was performed to test independent predictors of mortality. The positive predictive value of serum cystatin C and plasma creatinine for ARF and mortality was calculated by ROC analysis. RESULTS: ARF occurred in 54 patients (27%). Serum cystatin C showed excellent positive predictive value for ARF in critical illness by ROC analysis. In acute renal dysfunction, abnormal values of serum cystatin C and plasma creatinine appeared equally quickly (median 3 days). The diagnosis of ARF, the day 1 Apache II score and admission plasma creatinine appeared as independent predictors of hospital mortality. ROC analysis showed only weak predictive power for serum cystatin C and plasma creatinine regarding hospital mortality. CONCLUSIONS: Serum cystatin C was as good as plasma creatinine in detecting ARF in intensive care patients. Neither marker was clinically useful in predicting mortality.

Acute Kidney Injury↗
PubMed1991

[Ultrasonographic study on kidneys in patients with acute renal failure].

Ultrasonotomograms of 22 kidneys were obtained in 11 patients with renal-acute renal failure (renal-ARF). The underlying diseases of renal-ARF were acute tubular necrosis in 8 patients and acute on-set chronic glomerulonephritis in 3 patients. They were treated by hemodialysis in 10 patients and intermittent peritoneal dialysis in 1 patient. Ultrasonic measurement of the size of kidneys revealed that the thickness (anterior-posterior diameter) and the ratio of thickness to length (T/L) were greater in patients with ARF than in those with chronic renal failure and normal renal function. The patients with a low value of T/L (under 0.60) had a significantly greater urine volume than those with high a value of T/L (0.60 or more). The sonographic features of renal-ARF kidneys were marked increase in parenchymal echogenicity and appearance of hypoechoic swollen renal pyramids with sharpness of the corticomedullary border. In the course of ARF, these sonographic changes gradually disappeared when the patients had recovered from ARF. However, the prognosis was poor in patients with severer sonographic findings. We believe that repeated ultrasonic examination of the kidneys in patients with renal-ARF is useful for not only differential diagnosis of post-renal urinary obstruction but evaluating the course of ARF.

Acute Kidney Injury↗
PubMedDate not supplied

Pathophysiology of acute renal failure.

Acute renal failure (ARF) is a common renal disease affecting up to 5% of all hospitalized patients, with a higher prevalence of 10-30% in patients in critical care units (1-3). Despite advances in the management of critically ill patients and technological advances in renal replacement therapy, the high mortality of patients with ARF has not changed over the last decades and remains above 50% (4-6). Moreover, as a consequence of more advanced medical therapy and more complicated surgical interventions in older and multimorbid patients, the number of patients with ARF is increasing (1, 4, 5). Moreover, ARF itself increases the risk to develop additional complications that can be deleterious. Recently, an independent association between ARF and mortality has been shown in patients following administration of radiocontrast media in an intensive care unit and in patients following cardiac surgery (6, 7). Following radiocontrast media the mortality of patients with ARF was increased five fold and following cardiac surgery sixteen-fold as compared to patients with the same underlying disease without ARF. The pathophysiology of ischemic ARF is reviewed with the emphasis on the following mechanisms: Increased fractional excretion of sodium, Activation of tubuloglomerular feedback, Cytoskeletal disruption, Tubular obstruction, Vascular mechanisms. The following mediators will also be discussed: Calcium, Cysteine proteases, Nitric oxide, Adhesion receptors and integrins.

Acute Kidney Injury↗
PubMed2001

The alternative reading frame tumor suppressor inhibits growth through p21-dependent and p21-independent pathways.

The alternative reading frame (ARF) tumor suppressor mediates growth arrest or apoptosis through activation of the p53 tumor suppressor. A prevailing concept is that ARF uses p21Cip1/Waf1, a p53-responsive gene and cyclin-dependent kinase (Cdk) inhibitor, to block cell cycle progression. Using p21 nullizygous cells, we demonstrate that p21 is nonessential for the antiproliferative activity of ARF and p53, although it likely governs the arrest through Cdk inactivation when present. ARF overexpression in p21-positive and p21-negative mouse embryo fibroblasts (MEFs), but not in primary cells lacking p53, induced a biphasic (G1 and G2) cell cycle arrest. The ARF-induced growth arrest, regardless of p21 status, coincided with activation of p53 and accumulation of hypophosphorylated retinoblastoma protein (retinoblastoma protein). In ARF-arrested p21-positive cells, the presence of growth-inhibitory retinoblastoma protein correlated with an absence of Cdk2-dependent kinase activity, an increase in p21 association with inactive Cdks, and a lack of cyclin A expression. In contrast, p21-/- mouse embryo fibroblasts were arrested by ARF despite containing elevated levels of cyclin A protein and highly active Cdk2-dependent kinases. These findings provide evidence that ARF can block growth through a p21-independent pathway(s) that overrides Cdk2 activation.

3T3 Cells↗
PubMed2002

Acute renal failure mortality in hospitalized African Americans: age and gender considerations.

The aging kidney is at risk for both toxic and hemodynamic-induced acute damage, resulting in a high incidence of acute renal failure (ARF) in elderly patients. The effect of age and or gender in ARF mortality in African Americans (AA) was studied in a 3-year, computer assisted retrospective review. In an inner city medical center, 100 patients classified as ARF at discharge or expiration were included in the study. Patients were classified into 3 age categories: <40, 40-64, and >64 years. The incidence of ARF was 35%, 28% and 37%, respectively. Patients >64 years of age were less likely to be dialyzed. Both pre- and postrenal causes of ARF were more common in patients >64 years of age than in younger patients. Hospital length of stay increased progressively with age. Mortality was lower in patients >64 years of age than in younger patients. The incidence of ARF was higher in male than female patients and the incidence of sepsis was higher in female than male patients. Dialytic need was greater in male patients, but mortality was higher in female than male patients. Multivariate logistic regression showed that in the presence of sepsis, oliguria and mechanical ventilatory support, the relative risk of mortality associated with advanced age was 16.5, the relative risk of mortality associated with female gender was 0.2. In summary, hospitalized elderly African-American patients have a high incidence of ARF, and patients less than 40 years of age are equally at risk. Although mortality was higher in female patients, gender and advanced age did not independently contribute to high mortality. Neither age nor gender considerations should supplant sound clinical judgment in the management of and decision making in elderly African-American patients with ARF.

Acute Kidney Injury↗
PubMed2002

Systemic complications of acute glomerulonephritis in Nigerian children.

This study was undertaken to: (i) determine the prevalence, pattern and outcome of systemic complications of acute glomerulonephritis (AGN), and (ii) evaluate some clinicolaboratory features of the disease in Nigerian children. Clinical and laboratory records of consecutive cases of AGN seen over a period of 3 years in our unit, were prospectively entered into nephrology record forms and later analysed. Some of the analysed data included age, sex, blood pressure, types of systemic complication, haematocrit, plasma electrolytes, urea, creatinine, protein and albumin. Fractional excretion of filtered sodium (FeNa, %) and 24-hours urinary protein concentration data were also analysed. Majority of the patients (18/29) were under 6 years of age, with peak age incidence of 3 years. The hospital incidence of AGN and prevalence of systemic complications were 10 new cases per year and 41.38%, respectively. Heart failure (HF) and acute renal failure (ARF) were sole systemic complications in 7 and 2 AGN patients, respectively. Three patients had double systemic complications: one each of hypertensive encephalopathy (HTE)+HF, HTE+ARF and ARF+HF. Ten of 29 patients (34.48%) had nephrotic range proteinuria. None of the AGN patients except those with ARF had FeNa >1%, plasma bicarbonate <15 mmol/l, urea 225 mmol/l and creatinine 2400 mmol/l. Two of the patients died: one each of ARF and ARF+HF, giving a case fatality and mortality rate of 6.90% and 0.08%, respectively. ARF is clearly the principal risk factor for mortality in our AGN patients. Its early detection and aggressive but purposive management which must include dialysis, will certainly improve outcome in AGN cases complicated by ARF.

Acute Disease↗
PubMedDate not supplied

Genetic alterations of INK4alpha/ARF locus and p53 in human hepatocellular carcinoma.

The INK4alpha/ARF locus encodes p14(ARF) and p16(INK4alpha) , that function to arrest the cell cycle through the p53 and RB pathways, respectively. Genetic alterations of p14ARF and their relationship with p16(INK4a) or p53 inactivation have not been characterized in hepatocellular carcinoma (HCC). We examined 40 pairs of HCCs/noncancerous liver tissues for homozygous deletions (HD), methylation and mutations of the INK4a/ARF locus and for mutations of p53, and analyzed their clinicopathological correlation. p16(INK4a), p53 and p14(ARF) were inactivated in 62.5% (25 out of 40), 42.5% (17 out of 40) and 20% (8 out of 40) of HCCs, respectively. Inactivation of p14(ARF) was always associated with the concomitant inactivation of p16(INK4a) and occurred more frequently in hepatitis C virus (HCV)-associated HCC (p=0.042). Inactivation of p16INK4a) occurred more frequently in older patients (p=0.0027. The predominant mechanism of inactivation of p14(ARF) was homozygous deletion (7 out of 8), while that of p16(INK4a) was methylation (21 out of 25). Although statistically insignificant, genetic alterations of p14(ARF) tended to occur in tumors with wild-type p53. Genetic alterations of the INK4alpha/ARF locus could occur in small HCCs. In contrast, p53 mutations occurred more frequently in advanced HCCs (p=0.041). Inactivation of either p14(ARF)/p53 or p16(INK4a) occurred in 80% (32 out of 40) and concomitant disruption of both pathways occurred in 40% (16 out of 40) of HCCs, respectively. These results suggest that p14(ARF), p16(INK4a) and p53 are differentially disrupted through distinct molecular mechanisms at different stages in HCC and that p14(ARF) and p53 appear to function in the same tumor suppression pathway in HCC

Adult↗
PubMed2005

Acute renal failure associated with the use of traditional folk remedies in South Africa.

The use of folk remedies is widespread throughout Africa. Acute renal failure (ARF) is one of the most severe, but under-recognized, complications of folk remedy use. This report aims to describe the clinical presentation, outcomes, and nature of renal injury in patients with folk-remedy-associated ARF. Clinical data were evaluated retrospectively in 78 patients with ARF associated with recent folk remedy use. ARF was defined as elevated serum urea and creatinine above the age-appropriate normal ranges, persistent oligoanuria, worsening renal function with time, or need for dialysis. Overall mortality in patients with ARF was 41%. Mortality was higher in adults (45.5%) than in infants (36.6%), in patients with both renal and liver dysfunction (62.5%) than in those with renal dysfunction alone (22.6%), and in HIV-positive (44.4%) versus HIV-negative (34.6%) patients. Vomiting (51.3%) and diarrhea (43.6%) were the most frequent presenting symptoms. Metabolic acidosis (80.8%) and volume depletion (62.8%) were the most frequent clinical findings. The definable causes of ARF were pre-renal (26.9%), acute tubular necrosis (ATN; 26.9%), hepatorenal syndrome (6.4%), urinary tract infection/sepsis (7.7%), and primary renal disorders (7.7%). Twenty-seven patients had concomitant medical conditions unlikely primarily related to folk remedy ingestion. In conclusion, ARF occurring after use of folk remedies in South Africa is associated with significant morbidity and mortality. The most common contributors to ARF in this setting are volume depletion and ATN. Significantly, although a proportion of patients have underlying systemic or renal conditions that may contribute to renal dysfunction, in the majority of patients, folk remedy use appears to be the most likely proximate cause. In view of the large numbers of Africans living abroad, more widespread awareness of this important clinical problem needs to be raised.

Acute Kidney Injury↗
PubMed1992

Characterization of the human gene encoding ADP-ribosylation factor 1, a guanine nucleotide-binding activator of cholera toxin.

Mammalian ADP-ribosylation factors (ARFs), approximately 20-kDa guanine nucleotide-binding proteins that stimulate cholera toxin ADP-ribosyltransferase activity, were grouped into three classes based on deduced amino acid sequence. Human ARF 1, a class I ARF, is identical with its bovine counterpart, has a distinctive pattern of tissue and developmental expression, and is encoded by a approximately 1.9-kilobase mRNA. ARF 1 cDNAs were isolated from a human fibroblast cDNA library; one arose via an alternative polyadenylation signal (AA-TACA) 84 nucleotides 5' to the polyadenylation signal (AATAAA) used in the 1815-base pair cDNA. The polyadenylation signals, their respective locations, and the surrounding nucleotide sequences are conserved in human and rat. The human ARF 1 gene, with four introns, spans approximately 16.5 kilobases. Exon 1 (46 base pairs) contains only untranslated sequence. Translation initiates in exon 2, which encodes the sequence GXXXXGK involved in phosphate binding (GTP hydrolysis). The sequence DVGG is encoded in exon 3, and NKQD, which is involved in the interaction with the guanine ring, is interrupted following the codon for Q by intron 4. The carboxyl-terminal 53 amino acids and greater than 1110 base pairs of 3'-untranslated region are encoded in exon 5. Primer extension and mung bean and S1 nuclease mapping indicated multiple transcription initiation sites and were consistent with Northern analyses. The 5'-flanking region has a high GC content but no TATA or CAAT box, as found in housekeeping genes. In addition, the two human class I ARF genes, ARF 1 and ARF 3, have similar exon/intron organizations and use GC-rich promoters.

ADP-Ribosylation Factors↗
PubMed2006

Infection as a risk factor in the outcome of patients with acute renal failure assessed by SOFA score.

Acute renal failure (ARF) is a complex syndrome, frequently reported with mortality in 20-80% of the patients. Infection, as a cause or a complication of the syndrome, is a risk factor which unfavourably determines the outcome. A prospective 4-year study was performed of 112 ARF patients in the intensive care unit (ICU), with an evaluation of 68 clinical and laboratory parameters, as risk factors, at admission to the ICU. The scoring system used was SOFA (Sepsis-related Organ Failure Assessment). The outcome was associated with 27 risk factors among which infection as an acute ARF insult has shown a particularly strong correlation (p<0.0001). There was no association with infection as an intra-hospital complication. When divided according to the outcome (survivors vs. non-survivors), platelets, hematocrit, total protein and mean arterial pressure were significantly higher, while leucocytes and bilirubin significantly lower in the surviving group of patients. The parameters of the SOFA scoring system, such as the coagulation, liver and cardiovascular code, were statistically significant in relation to the outcome, and also the SOFA score taken as an independent variable (p<0.0001). The classification matrix of the analyzed SOFA scoring system was successful in the classification of 91.95% of the surviving and 48.00% of the non-surviving patients with ARF and the odds ratio was 41.0. Mortality rate in patients with ARF is 22.7%. Patients with ARF due to sepsis have a worse prognosis than those with non-septic ARF. Coagulation disorder, liver and cardiovascular dysfunction, as well as the SOFA score itself are independent variable in the outcome prediction. The SOFA score, derived from easily obtained data, is useful for judging survival prognosis in patients with ARF.

Acute Kidney Injury↗
PubMedDate not supplied

Acute renal failure in intensive care unit: which factors predict future dialysis dependency?

Management of acute renal failure (ARF) in an intensive care unit (ICU) is difficult. The aim of this study was to identify prognostic factors determining ARF outcome in the ICU in terms of dialysis dependency or independency. We included 35 patients who turned out to be dialysis dependent (DD) and 11 patients who turned out to be dialysis independent (DI) after ARF in the ICU, which necessitated renal replacement therapy. In the post-ARF period, acetylsalicylic acid was protective against dialysis dependency (p < 0.05, odds ratio [OR] = 0.078) and dopamine increased the likelihood of dialysis dependency (p = 0.016, OR = 10.6). Multiorgan dysfunction (p = 0.001, OR = 13.6), especially cardiac (p = 0.009) and hepatic failure (p < 0.0001) were determined to increase risk of dialysis dependency. Mean systolic blood pressures during the first 24 hours (p = 0.023) and 24-48 hours (p = or < 0.0001), mean diastolic blood pressures during first the 24-48 hours (p = 0.03) and 48-72 hours of ARF in ICU (p = 0.023) and at discharge (p = 0.03) were significantly lower in the DD group than in the DI group. Mean thrombocyte counts at hospitalization (p = 0.034), during the first 24 hours (p = 0.019) and 24-48 hours of ARF in ICU (p = 0.038) were lower in the DD than DI group. This study demonstrates the very early prognostic factors influencing ARF outcome in terms of dialysis dependency. Early thrombocyte count and systolic blood pressure and follow-up diastolic blood pressure were prognostic factors for ARF outcome. Acetylsalicylic acid seemed to improve renal outcome, whereas dopamine seemed to worsen the disease process.

Acute Kidney Injury↗
PubMed2006

Acute renal failure in the intensive care unit.

BACKGROUND: Acute renal failure (ARF) in the intensive care unit (ICU) is associated with high mortality. A thorough understanding of the clinical spectrum of the disease is needed in order to devise methods to improve the final outcome due to this problem. AIMS AND OBJECTIVES: The aim of the present study was to analyze the clinical spectrum, causes, risk and prognostic factors and final outcome of ARF in the setting of ICU. METHOD: This prospective study involved patients admitted to ICU during the period between September 2003 to January 2005 (17 months). Patients who developed ARF during the ICU stay were included in the study. The clinical and laboratory data were collected at admission and then on daily basis. Data recorded included; patient characteristics, underlying medical conditions responsible for ICU admission, dialytic status, need for ventilation, total duration of ICU stay, APACHE-III score and final outcome, and these data were analyzed for predicting survival using univariate and multivariate analysis. RESULTS: Twelve hundred and fifteen (1215) patients were admitted to ICU from September 2003 to January, 2005 and 46 (3.79%) patients developed ARF after admission to ICU. Mean age of patients was 44.9 +/- 17 years and 56.5% were males. Comorbidity was seen in 24 (52%) patients; hypertension (34.7%), diabetes mellitus (28.3%), coronary artery disease (30.4%) and chronic kidney disease (13%). ARF had developed complicating medical and surgical conditions in 33 (71.7%) and 11 (23.7%) patients respectively. The etiology of ARF was multifactorial and included; hypotension (71.74%), volume depletion (17.4%), nephrotoxic drugs (67.39%), and sepsis (69.5%). Multiple organ system failure (MOSF) was noted in 63% of cases and dialysis was required in 25 (54.3%) patients. Mortality occurred in 63% of patients. MOSF and sepsis were found to be significant adverse prognostic factors when multiple logistic regression analysis was done. CONCLUSIONS: ARF was seen in 3.79% of cases in our ICU and associated with poor prognosis. Presence of sepsis, MOSF, higher APACHE--III scores and ventilation need were correlated with higher mortality in ARF patients in the intensive care unit.

Acute Kidney Injury↗