This is to certify that this dissertation entitled “ANALYSIS OF ACUTERENALFAILURE IN POISON CONTROL AND TOXICOLOGY TRAINING CENTRE” submitted by Dr. R. SAKTHIRAJAN, appearing for Part II M.D. Branch I General Medicine Degree examination in March 2008 is a bona fide record of work done by him under my direct audience and supervision in partial fulfillment of regulations of the Tamil Nadu Dr. M.G.R. Medical University, Chennai. I forward this to the Tamil Nadu Dr.M.G.R. Medical University, Chennai, Tamil Nadu, India.
Acute Renal Failure Requiring Dialysis A 5 Year series ORIGINAL ARTICLE Acute Renal Failure Requiring Dialysis A 5 Year series L S Hooi, MRCP, Department of Medicine, Hospital Sultanah Aminah, Johor B[.]
Summary: Mortality associated with acuterenalfailure (ARF) remains high despite of developments in therapy strategies and definition of different prognostic factors. Therefore, this study focused on to define new prognostic factors and espe- cially regional characteristics of the ARF patients. One hundred fifteen ARF patients, diagnosed from November 1998 to May 2003, were included to this prospective and observational study. Clinical features, laboratory parameters, Acute Physiology and Chronic Health Evaluation (APACHE) III scores and co-morbid conditions of the patients were examined. Clinical and laboratory data, and APACHE III scores were recorded at the first nephrology consult day. Thirty of the pa- tients (26%) died. APACHE III scores, presence and the total number of co-morbid conditions and serum albumin levels at the time of first nephrology consultation were found as independent predictors of mortality. There was a negative cor- relation between APACHE III scores and serum albumin levels. Not only increased APACHE III score and presence of co-morbid conditions but also low serum albumin level was found as the predictors of mortality. However, only serum albu- min level is seen as modifiable prognostic factor among these parameters. Therefore, further studies are necessary to de- termine the causes of hypoalbuminemia in patients with ARF and the effect of it’s effective treatment on patients outcome.
Determination of the optimal dose of renal replacement therapy in critically ill patients with acute kidney injury has been controversial. Questions have recently been raised regarding the design and execution of the US Department of Veterans Affairs/National Institutes of Health AcuteRenalFailure Trial Network (ATN) Study, which demonstrated no improvement in 60-day all-cause mortality with more intensive management of renal replacement therapy. In the present article we present our rationale for these aspects of the design and conduct of the study, including our use of both inter- mittent and continuous modalities of renal support, our approach to initiation of study therapy and the volume management during study therapy. In addition, the article presents data on hypotension during therapy and recovery of kidney function in the perspective of other studies of renal support in acute kidney injury. Finally, we address the implications of the ATN Study results for clinical practice from the perspective of the study investigators.
Acuterenalfailure is one of the important disease in the causation of mortality and morbidity in children. Various conditions leading on to ARF by themselves can lead on to various other non-renal complications thereby contributing to mortality and morbidity. In a modern world with advancement in technology one should expect everyone to prevent acuterenalfailure from occurring. Pre-renal azotemia and intrinsic renalfailure continue to play a major role in causing morbidity and mortality in children. In the present study, the maximum number of cases of ARF was reported between the ages of 1 to 4 years. This is correlated with the studies conducted by Corlos et al and Trornpeter et al. 1,2 This is because of the
Although hypercalcemia is a known metabolic complication of sarcoidosis, it is rarely a presenting manifestation. Hyper- calciuria is the most common defect of calcium metabolism with a prevalence of 50–62% [1–3]. Although hypercalcemia in 11% and renal calculi in 10% of patients with sarcoidosis has been reported , clinically significant hypercalcemia is less frequent and is generally asymptomatic, occurring in less than 5% of patients . Persistent untreated hypercalcemia and hypercalciuria can lead to nephrocalcinosis, renal calculi, and renalfailure . We report two cases of sarcoidosis, where the initial presentation was markedly elevated serum calcium levels and acuterenalfailure, which presented a diagnostic challenge.
I DR. M. JESU ANTONY EZHIL ARASU, solemnly declare that dissertation titled “OUTCOME OF PERITONEAL DIALYSIS IN THE MANAGEMENT OF ACUTERENALFAILURE” is a bonafide work done by me at Govt Stanley Medical College and Hospital from march 2005 to July 2006 under the guidance and supervision of my unit chief PROF. V.RUKMANI, M.D. Addl. Professor of Medicine.
Since human acuterenalfailure (ARF) is frequently the result of multiple rather than single insults, we used a combination of treatments to induce ARF in rats. Uninephrectomized, salt-depleted rats injected with indomethacin developed ARF after administration of radiocontrast. After 24 h, the plasma creatine rose from 103 +/- 3 to 211 +/- 22 mumol/liter (mean +/- SE) and the creatinine clearance dropped from 0.7 +/- 0.1 to 0.2 +/- 0.04 ml/min (P less than 0.001). Severe injury was confined to the outer medulla and comprised necrosis of medullary thick ascending limbs (mTALs), tubular collapse, and casts. Other nephron
Postischemic acuterenalfailure (ARF) induced by cardiac surgery is commonly prolonged and may be irreversible. To examine whether persistence of postischemic, tubular cell injury accounts for delayed recovery from ARF, we studied 10 patients developing protracted (36 +/- 4 d) ARF after cardiac surgery. The differential clearance and excretion dynamics of probe solutes of graded size were determined. Inulin clearance was depressed (5.0 +/- 1.7 ml/min), while the fractional urinary clearance of dextrans (radii 17-30 A) were elevated above unity. Employing a model of conservation of mass, we calculated that 44% of filtered inulin was lost via transtubular backleak. The clearance and fractional backleak of
Introduction: Acuterenalfailure (ARF) is a medical emergency that does not spare children. Its interest lies in the search for etiologies and management made difficult by the poor quality of hospital technical platform in Africa. Objectives: To improve the management of ARF in children, determine its prevalence, and identify the causes and factors associated with mortality. Patients and Methods: We reviewed the records of children from one month to 17 years hospitalized between January 2016 and December 2018 in every pediatric department at the University Hospital of Brazzaville and included those whose discharge diagnosis included the item “ARF”. Study variables were age, sex, source, (para)clinical signs, stage and type of ARF, etiology and evolutionary profile. Results: In- cluded were 18952 hospitalized children out of whose 253 had ARF 1.3%. There were 145 (57.3%) boys and 108 (42.7%) girls with an average age of 71.5 months. The mean time to consultation was 8.1 days. ARF was at failure stage in 147 cases (58.1%). It was functional in 210 cases (83.0%), out of which 95.1% re- sulted from severe dehydration. No extra-renal treatment was performed. Le- thality was 34.4%. Hypovolemic shock (56.3%), severe sepsis (18.4%) and se- vere malaria (14.9%) were the main causes. Young age, provenance of the child, severe dehydration, deep coma, oligoanuria, stage of failure, hyperkalemia, ab- sence of an extra-renal purification center were factors associated with mortali- ty (p < 0.0002). Conclusion: The high prevalence of ARF and its lethality re- quires public health actions including proper management of dehydration and malaria but also the creation of an extra-renal purification center.
Prospective study of acute renal failure in a general hospital Med J Malaysia Vol 42 No 4 December 1987 PROSPECTIVE STUDY OF ACUTE RENAL FAILURE IN A GENERAL HOSPITAL ABU BAKAR SULEIMAN FRACP ZAKI MOR[.]
Background: Myoglobinuric acuterenalfailure induced by glycerol injection is characterized by ischemic injury, vascular congestion, and the appearance of reactive oxygen metabolites. This is the first study to examine the role of Olmesartan in attenuating glycerol-induced rhabdomyolysis was examined. Methods: Male Wistar rats were deprived of water for 24 hours; then given intramuscular glycerol injections intramuscularly with 10 mL/kg body weight of 50 % glycerol for group 2 and 3. Rats in group 3 were treated for 6 consecutive days with Olmesartan 3 mg/kg body weight. An hour after the last dose, a blood samples were collected so that renal function could be assessed. Then the rats were sacrificed to get kidneys, one for histological investigations, and the other for enzyme assays. Results: A significant increase in the levels of urea and creatinine, and a significant decrease in the activity of reduced glutathione was detected in glycerol-induced rats; these markers were reversed upon Olmesartan treatment. The biochemical data were supported by evaluation with kidney histopathology. All these effects induced by glycerol were attenuated upon treatment with Olmesartan. Olmesartan treatment has improved all the studied marks that induced by glycerol. Conclusion: these findings suggest that Olmesartan can significantly diminish kidney damage by glycerol.
To further evaluate the mechanism of the oliguria of acuterenalfailure, a model was utilized in which intense and prolonged vasoconstriction produced the unilateral cessation of urine flow. The radioactive microsphere method was used to measure total and regional blood flow before and after the intrarenal infusion of norepinephrine, 0.75 µg/kg/min, for 2 h in the dog. In the control kidney, renal blood flow increased 32% 48 h after norepinephrine in association with a fall in the fractional distribution of flow to the outer cortex. In the
The renal handling of phosphorus was evaluated in rats with acuterenalfailure (ARF) induced by injection of mercuric chloride (HgCl 2 ). Clearances of endogenous creatinine (Ccr) and of phosphorus (Cp) were measured in the following groups: 1. Intact animals (control); 2. Parathyroidectomized rats (PTX) with normal kidney function (PTX control); 3. Animals with mercury-induced acuterenalfailure (Hg-ARF); 4. PTX rats with Hg-ARF; 5. Rats with Hg-ARF maintained normophosphatemic with dietary phosphate restriction; 6. Animals with oliguric ARF following renal artery constriction; 7. Rats with unilateral Hg- ARF. In addition, radioinulin clearances were measured in 6 normal and in 14 azotemic animals and correlated with simultaneously recorded endogenous Ccr. Radioinulin
hypersensitivity to renal nerve stimulation (RNS) and paradoxical vasoconstriction to renal perfusion pressure (RPP) reduction in the autoregulatory range in 1 wk norepinephrine (NE)-induced acuterenalfailure (ARF) in rats were investigated. Renal blood flow (RBF) responses were determined before and during intrarenal infusion of an AII and TXA2 antagonist. Saralasin or SQ29548 alone partially corrected the slopes of RBF to RNS and RPP reduction in NE-ARF rats (P less than 0.02). Saralasin + SQ29548 normalized the RBF response to RNS. While combined saralasin + SQ29548 eliminated the
multiple organ systems such as cardiovascular, renal, hepatic, hematologic and central nervous system. In addition, these pregnancies are associated with multiple complications including abruptio placentae, fetal death, DIC, HELLP syndrome, pulmonary edema, sepsis and postpartum hemorrhage that requires massive transfusion. Consequently, the above changes predispose such patients to an increased risk of acuterenalfailure. 4 The
Pregnancy related acuterenalfailure (PRARF) is still a critical complication in obstetrics. In the present study 79 cases out of 9270 deliveries were diagnosed as acuterenalfailure related to gestational problems showing an incidence of 0.87%. Since the 1960s, the overall incidence of PR-ARF has decreased from 1/3000 to 1/15,000 –1/20,000 births (Gammill and Jeyabalan, 2005). According to Silva et al and Prakash et al incidence were 0.08% and 1.78%, respectively (42,36) . In our study most of the patients (92.44%) were coming from poor families. The age of the patients ranged from 17 to 40 years with a mean of 23.23± 5.03 years. It was seen that more than 70% patients were less than 30 years of age 32 (40.50%) patients were below 20 years of age. In the study conducted by Sivakumar et al the mean age was 25.6 yrswith range of 15 -45 yrs (Sivakumar et al., 2011). Patel et al reported the age range between 20 to 41 years with a median of 28 years (Patel et al., 2013), while N. Arora et al found more than 90% of their participants to be younger than 30 years of age (mean 25±4.5 years) (Arora et al., 2010). A total of 45 (56.96%) patients had developed acuterenalfailure in their first pregnancy either in the antepartum or postpartum period. This was in contrast to the study of Rizwan et al, where most of the (62.85%) patients were multipara (NaushabaRizwan and Syed FarhanUddin, 2011). Patel et al however found that 28 (46.7%) women were multipara and 32 (53.4%) women were primigravida in their study (Patel et al., 2013). As the study was conducted in a tertiary care centre majority of the cases (84.81%) were referred cases from the peripheral centres. According to the 2005-2006 National Family Health Survey, only 50% of the pregnant women in India had at least three prenatal check-ups. Incomplete coverage of prenatal care could be an important underlying factor in these complications which is being missed in their initial stages (International Institute for Population Sciences (IIPS) and ORC Marco, 2007). In our study most of the cases had institutional deliveries. PRARF was found more common after cesarean section (51.89%). Sivakumar et al found 33.89%