Clinical Study of Acute Renal Failure

Kim, Jae Pill; Choi, Nam Su; Lim, Sung Shick; Lee, Sang Eog; Hong, Hwa Jung; Hong, Seong Pyo; Lee, Tae Won; Ihm, Chun Gyoo; Kim, Myung Jae; Park, Won Do; Kim, Yeong Hoon

Abstract

OBJECTIVE
Acute Renal Failure is a clinical syndrome characterized by a sudden decrease in renal function which was previously normal. Despite advances in medical care, prognosis in ARF is variable according to the influence of demographic factors, severity of ARF, nature of disease causing ARF, coexisting disease, treatments applied, and complications. We studied the recent changes of clinical feature of ARF.
METHODS
We studied retrospectively 245 patients with ARF who had been hospitalized at Kyung Hee University Hospital between February 1988 and March 1993.
RESULTS
1) Male to female sex ratio was 1.8 : 1, and the incidence was high in above fifth decade (67.8%). 2) Acute renal failure was classified, according to clinical background, into medical group 79.6% (195 cases) and surgical group 20.4% (50 cases), and oliguric group 40.8% (100 cases) and non-oliguric group 59.2% (145 cases). 3) Acute renal failure due to medical causes included ARF by hemorrhagic fever with renal syndrome (25.6%), drugs and chemicals (17.9%), sepsis (17.4%) and systemic infection (7.7%) etc. ARF due to surgical causes included ARF by multiple trauma (34%), various surgical procedures (30%), surgical sepsis (14%), burn (12%) etc. 4) During admission, the expired patients had more severe biochemical and clinical characteristics including high BUN and serum potassium (p<0.01), lower serum albumin (p<0,01) than those of survivor. 5) Infections as the cause of ARF were 107 cases (43.7%), which included hemorrhagic fever with renal syndrome 50 cases, sepsis 31 cases, urinary tract infection 7 cases and respiratory tract infection 6 cases etc. The most common infecting organism was Hantavizus (50.5%). There was a greater number of gram-negative organisms than gram-positive organisms (34.1% vs 9.9%). 6) The overall mortality rate in patients with ARF was 31.4Fo. The presumptive causes of death were underlying disease (59.7%) such as sepsis, acute poisoning, cardiogenic and hypovolemic shock, and respiratory failure (14.3%), hyperkalemia (9.1%), pulmonary edeme (6.5%), and metabolic aidosis (2.6%) in order of frequency. 7) The highest mortality rate was 42.6% in patients above 50 years old. Mortality rate in patients with ARF due to surgical causes (52.0%) was significantly high than that of medical causes (26.2%) (p<0.05). Among the expired patients, oliguric group was 72.7%. In conclusion, there have been major trends in the clinical features of acute renal failure in this study. Especially, significant increase in the number of elderly patients, non-oliguric patients, and medical causes such as hemarrhagic fever with renal syndrome or sepsis were observed. Survival rate significantly decreased with increasing age, in acute renal failure by surgical causes, in oligurie patients, and in the presence of complicating factors such as sepsis or shock.