Injuria renal aguda Aspectos epidemiol gicos Dr. Jord

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Injuria renal agudaAspectos epidemiológicos

• Dr. Jordán Tenzi
• 9/7/07

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Liaño F, Pascua J and The Madrid Acute Renal
Failure Study Group, Kidney Int 1996 50 8111-818

• Incidencia 209/millón/año (748/4.227.837)
• Etiología
• -NTA 45
• -Prerrenal 21
• -IRC agudizada 13
• -Obstructiva 10
• Origen
• Extrahospitalario 49.7
• Hospitalario 50.3
• -Medicina 34
• -UCI 27
• -Cirugía 23
• Sexo predominio masculino
• Edad incidencia aumenta con la misma

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Liaño F, Pascua J and The Madrid Acute Renal
Failure Study Group, Kidney Int 1996 50 8111-818

• Mortalidad 45
• NTA 60
• Prerenal 35
• IRC agudizada 35
• Obstructiva 27
• Nefritis intersiticial aguda 13
• Vasculitis 45
• Glomerulonefritis primaria 9
• Glomerulonefritis secundaria 25

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Ympa YP, Sakr Y, Reinhart K, et al. Has
mortality from acute renal failure decreased? A
systematic review of the literature. Am J Med
2005 118 827832.
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The epidemiology of acute renal failure 1975
versus 2005
Curr Opin Crit Care 12557560. 2006
Bellomo R,
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Crit Care Clin 21 (2005) 357 366
Ricci Z,Ronco C,
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• AKI incidence of 5 (109 of 2216 medical and
  surgical patients). AKI was associated with
  decreased renal perfusion (42), major surgery
  (18), radiocontrast exposure (12), and
  aminoglycoside administration (7). Predictors of
  poor prognosis included oliguria and the severity
  of the renal dysfunction.

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• Compared a cohort of 183 patients with
  radiocontrast-associated AKI and 174 patients who
  were matched for age and baseline SCr and
  underwent similar diagnostic procedures without
  developing AKI.
• The mortality rate was 34 in patients with AKI
  versus 7 in patients without AKI. Adjusting for
  differences in comorbidity, the odds of death
  were increased 5.5-fold in the AKI group.

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Curr Opin Crit Care 12531537. 2006
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Curr Opin Crit Care 12531537. 2006
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Curr Opin Crit Care 12538543. 2006
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Uchino S, Kellum JA, Bellomo R et al
JAMA. 2005294813-818
For the Beginning and Ending Supportive Therapy
for the Kidney (BEST Kidney) Investigators
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• From this population, only patients who were
  treated with renal replacement therapy (RRT)
• other than for drug poisoning or who had at
  least 1 of the predefined criteria for ARF were
  included in the study.
• The criteria for ARF were oliguria defined
• as urine output of less than 200 mL in 12
  hours and/or marked azotemia defined as a blood
  urea nitrogen level higher than
• 84 mg/dL

Uchino S, Kellum JA, Bellomo R et al
JAMA. 2005294813-818
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Uchino S, Kellum JA, Bellomo R et al
JAMA. 2005294813-818
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Uchino S, Kellum JA, Bellomo R et al
JAMA. 2005294813-818
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Rialp G, Roglan A Renal Failure 1996 18
667-675

• Incidencia de IRA en UCI 21.4
• AP HTA 34.2 inmunodepresión 27.3
• diabetes 17.5
• Mortalidad con IRA 46.6 p 0.0001
• sin IRA 17.6

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• Injuria Renal Aguda en Medicina Intensiva
  Encuesta Multicéntrica NacionalJ Tenzi, A
  Ferreiro, R Lombardi, E Schwedt, N Nin, M
  Cancela, F Gonzalez y colaboradores
• 2006

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• Montevideo 18 instituciones (25 UCI)
• Interior 15 instituciones (15 UCI)
• Total UCI encuestadas 40 (83)
• UCI Montevideo encuestadas 100
• UCI Interior encuestadas 65
• Incidencia de IRA 9.12 (66/723)

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• Mortalidad pacientes con IRA 32/66 (48.5)
• -Montevideo 23/53 (43.4)
• -Interior 9/13 (69.2)
• Mortalidad pacientes sin IRA 107/657 (16.2)
• -Montevideo 88/518 (16.9)
• -Interior 19/139 (13.6)

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• Sobreviven Fallecen Valor p
• DOM
• si 12 (35.3) 22 (64.7) lt 0.05
• DOM
• No 21 (67.7) 10 (32.3)