Acute renal failure in acute pyelonephritis

Sung, Su Ah; Kang, Young Sun; Lee, So Young; Kim, Sang Wook; Lee, Ji Eun; Han, Kum Hyun; Seo, Ji A; Cho, Won Yong; Kim, Hyoung Kyu

Abstract

BACKGROUND: If acute renal failure develops in patients with acute pyelonephritis, it is most commonly due to hypovolemia, sepsis, drug therapy or urinary obstruction. But there have been reported many cases about patients of acute renal failure derived from acute pyelonephritis itself without any predisposing factor. To find out the predisposing related factors, we analysed the clinical patterns of patients of acute pyelonephritis with acute renal failure compared to that of patients of acute pyelonephritis without acute renal failure.
METHODS
From January 1996 to December 2000, the authors identified 172 patients older than 16 years of age who admitted to Korea University Hospital for acute pyelonephritis. Among them, patients whose serum creatinine level had been less than 1.5mg/dL before admission and who did not have any of chronic renal failure, diabetic nephropathy or hypertensive nephropathy were recruited. According to the level of serum creatinine at admission, the patients were divided into two groups. If ones serum creatinine level at admission was less than 1.5mg/dL, he or she included to control group, if more than 1.5 mg/dL to acute renal failure group. And we compared their clinical features and laboratory values.
RESULTS
The patients with acute pyelonephritis complicated to renal failure showed the tendency of older age, more dehydration, more inflammation, more frequent abnormal findings in abdominal ultrasonography and more frequency of chronic systemic disease than those without renal failure. Acute renal failure due to acute pyelonephritis might be recovered rapidly by general supportive care like fluid replacement and adequate antimicrobial therapy.
CONCLUSION
Acute pyelonephritis should be considered rare cause of acute renal failure. Especially in case of old age, severe dehydration, severe inflammation and comorbidity with chronic systemic disease involved in kidney, it would be helpful to observe the clinical course closely.