Acute Renal Failure: Ten Years Experience Rubina Naqvi

1
Acute Renal FailureTen Years ExperienceRubina
Naqvi

• Sindh Institute Of Urology and Transplantation
  (SIUT), Dow Medical College, Karachi.
• PAKISTAN

2
Trends in ARF
Percent
120
11
3
12
14
52
9
22
100
24
17
18
80
18
31
47
11
33
12
60
28
2
40
78
18
68
67
57
55
60
50
45
45
20
30
0
Naqvi, Pak, 376, 1996
Naqvi, Present Study
Zewdu, Ethopia, 136, 1994
Rashid, BD, 120, 1993
Loo, Malaysia, 164, 1995
Beaman, UK, 250, 1987
Chugh, India, 1862, 1989
Prakash, India, 426, 1995
3
Developed vs Developing
4
Patients and Methods

• Data analysis of all patients with ARF ( serum
  creatinine of gt2 mg ) presented to SIUT
  between Jan.1990- Dec. 1999.
• Urgent identification of cause of ARF was sought
  from history and physical examination, routine
  haematological and biochemical investigations,
  urinanalysis and microscopy.
• Renal anatomy and size were defined by
  ultrasonography.
• Renal biopsy performed in cases where cause of
  ARF was unclear or there was a delayed response
  towards renal recovery.

5
Demography

• MF 1.41
• Age 1-100 yrs (mean 32.6)

6
Acute Renal Failuren2098( January
1990-December 1999 )

• Causes no.
• Medical 945 45
• Surgical 584 28
• Obstetrical 357 17
• Misc./ Unknown 212 10

7
Medical Acute Renal Failuren945

• Gastroenteritis 321 34
• Nephrotoxic Agents 134 14
• Malaria 124 13
• HRS 68 7
• GN/ vasculitis 84 9
• Rhabdomyolysis 67 7
• Snake Bite 39 4
• DIC/ Sepsis 31 3
• HUS 18 2
• Ac. Pancreatitis 13 1
• Misc.Causes 46 5

8
Nephrotoxic Agentsn134

• Aminoglycosides 70 52
• Analgesics 9 7
• Rifampicin 8 6
• Penicillines 6 4.4
• Contrast Agents 6 4.4
• Chemotherapeutic Agents 6 4.4
• Poisoning
• Phenobarbitone 5 5.0
• Organophos. Compounds 3 2
• Cu SO4 3 2
• Brake Oil 1 0.7
• Boiler water 1 0.7
• Unknown substance 16 12

9
Malarial Acute Renal Failuren124

• Malaria contributed to 5.9 of total ARF
• Diagnosis was made on identification of
  trophozoites of Plasmodium falciparum on
  peripheral blood film
• G-6PD was not found deficient in the cases where
  it was asked for, after recovery from acute
  illness
• 31/ 124 (25 ) patients of this group expired
• Factors associated with poor prognosis include
  cerebral involvement and coagulation abnormalities

10
Surgical Acute Renal Failuren584

• Obstructive Nephropathy 449 77
• Surgical Trauma 135 23

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Obstetrical Acute Renal Failuren357

• Intra Uterine Deaths 145
• Post Partum Haemorhage 117
• Ante Partum Haemorhage 113
• Sepsis/ DIC 60
• Abortion 49
• Pre-Eclampsia 40
• Post Partum Eclampsia 26

More than one cause in many cases
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Mode of Treatmentn2098

• Mode of Treatment no.of cases
• Haemodialysis 1855 88
• Peritoneal Dialysis 46 02
• Fluid Therapy 202 10
• Diversion Precedures 388 18

13
Outcome

• Recovered Expired Chronic Lost to follow
  up
• Medical 567(60) 189(20) 31(4) 158(16)
• n945
• Surgical 379(65) 64(11) 72(12) 69(12)
• n584
• Obstetrical 152(42) 51(14) 74(21) 80(22)
• n357
• Unknown 74(35) 49(23) 13(6) 76(36)
• n212

in parenthesis
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Renal Biopsiesn247

• ARF of Unknown Cause 171
• Delayed Recovery 76
• Acute Tubular Necrosis 93
• Acute Cortical Necrosis 53
• Acute Interstitial Nephritis 26
• Crescentic Glomerulonephritis 54
• Non-specific changes 21

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Conclusion

• Causative factors for Acute Renal Failure are
  different in developing countries then those from
  developed.
• Volume depletion resulting from GI loss and
  Obstetrical haemorrhages contribute to
  significant no.of cases of ARF pool.
• Approx.10 of cases can be managed by only
  appropriate fluid replacement.
• Preventable causes for ARF should be carefully
  looked into.

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my e-mail addresses rnaqvi_at_super.net.pk info_at_siut
.org