Changing Trends in Acute Renal Failure in Third-world Countries — Chandigarh Study

Abstract

The pattern of acute renal failure in third-world countries is changing albeit at a slower pace compared to that in developed countries. Of the 1862 patients with acute renal failure requiring dialysis between 1965 and 1986 in a north Indian centre, 60, 15 and 25 per cent were related to medical, obstetrical and surgical conditions respectively. Among the medical patients, diarrhoeal diseases which caused 23 per cent of the total number of cases of acute renal failure in the period 1965 to 1974 caused only 10 per cent in 1981 to 1986. In the same period, acute renal failure due to sepsis and drugs increased while that due to copper sulphate poisoning and intravascular haemolysis showed a downward trend. Obstetrical acute renal failure declined from 22 per cent in 1965 to 1974 to 9 per cent during the period 1981 to 1986. This decline was chiefly due to a fall in cases of septic abortion, puerperal sepsis and postpartum haemorrhage. Surgical acute renal failure increased from 11 per cent during the period 1965 to 1974 to 31 per cent in the 1980s, predominantly due to an increase in patients with obstructive uropathy. Despite these favourable trends, the pattern of acute renal failure in the third world continues to be different from that in the developed countries.