Community-Acquired Acute Renal Failure

doi:10.1016/S0272-6386(12)81128-0

American Journal of Kidney Diseases

Volume 17, Issue 2, February 1991, Pages 191-198

https://doi.org/10.1016/S0272-6386(12)81128-0 Get rights and content

Abstract

Acute renal failure usually occurs during hospitalization, but may also be present on admission to the hospital. To define the causes and outcomes of community-acquired acute renal failure, we undertook a prospective study of patients admitted to the hospital with acute elevations in serum creatinine concentrations. Over a 17-month period, all admission serum creatinine determinations were screened for patients with values greater than 177 δmol/L (2 mg/dL). These values were compared with baseline creatinines to select patients with an acute elevation in serum creatinine occurring outside the hospital. One hundred patients were entered into the study, with an overall incidence of 1% of hospital admissions. Seventy percent of the patients had prerenal azotemia, 11% had intrinsic acute renal failure, 17% had obstruction, and 2% could not be classified. Mean peak serum creatinine (318 ± 18 δmol/L [3.6 ± 0.2 mg/dL]) and mortality (7%) was lowest In the group with prerenal azotemia. In this group, volume contraction due to vomiting, decreased fluid intake, diarrhea, fever, glucosuria, or diuretics was the most common underlying cause. The group with Intrinsic acute renal failure had the most severe renal failure and the highest mortality (55%). Although ischemic acute tubular necrosis is the most common cause of hospital-acquired intrinsic acute renal failure, this etiology was seen in only one patient. Drug-induced nephrotoxicity and Infection-related causes were the most common underlying etiologies of intrinsic acute renal failure. Obstructive renal failure had a mortality of 24% and was most commonly due to benign prostatic hypertrophy. Almost 90% of the patients admitted to the hospital with an acute increase in serum creatinine concentration have a potentially reversible cause, either volume contraction or obstruction. Nevertheless, the overall mortality in these patients is 15%, and the risk of dying is increased in those patients with intrinsic acute renal failure and those with higher peak serum creatinine concentrations.

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^**: Current address of Dr Dhakal is the Renal Section, Wilkes-Barre Veterans Affairs Medical Center, Wilkes-Barre, PA, and that of Dr Patel is 9500-H Prince George Lane, Raleigh, NC.

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Community-Acquired Acute Renal Failure

Abstract

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