Abstract
Background: Sound prognostic data in sepsis induced acute renal failure (SARF) are lacking especially on the short term outcome [STO] in the intensive care unit [ICU]. We addressed the use of Tc-99m DMSA [2,3-dimercaptosuccinicacid] renal cortical imaging as a prognostic tool in SARF. Methods: Forty patients with acute renal failure due to sepsis [age range 15-74 years; median 44.5] were subjected for full history taking complete physical examination, routine ICU monitoring, routine laboratory investigations, APACHE II [Acute Physiology and Chronic Health Evaluation] and SOFA [Sequential Organ Failure Assessment] together with Tc-99m DMSA cortical renal scintigraphy. Patients’ death in the ICU or discharge was considered as the end point of the study representing the so-called short term outcome [STO]. Results: 25% mortality rate [10/40] was found along the admission period in the ICU. All non-survivors were abnormal with DMSA imaging [NPV & PPV 100% & 66.7% respectively]. Abnormal DMSA cases showed significant positive associations with serum creatinine at admission [r = 0.5; P 0.02]; admission duration [r = 0.4; P 0.002]; APACHE II score [r = 0.5; P 0.004] and STO [r = 0.4; P 0.03]. Statistically significant difference was elicited between subjects with normal and abnormal DMSA regarding the same parameters. Conclusion: This preliminary data could raise Tc-99m DMSA renal imaging as a prognostic tool in SARF that could allow influential interference to prohibit dramatic outcomes as mortality.
Highlights
Acute renal failure [ARF] is a sudden sustained decline in glomerular filtration rate [GFR] usually associated with uremia and a fall in urine output with a high mortality rate [1]
The renal uptake of Tc-99m DMSA parallels the renal function as determined by GFR and its uptake is significantly decreased in nephropathy [4,5] which is accepted as a poor prognostic sign [6]
Bernheim et al in 1976 proposed renal scintigraphic scanning as a tool to assess the prognosis of ARF using hippuran and concluded that its uptake was a parameter which authorized the prognosis of a favorable course whereas its absence permitted one to envisage an unfavorable course [7]
Summary
Acute renal failure [ARF] is a sudden sustained decline in glomerular filtration rate [GFR] usually associated with uremia and a fall in urine output with a high mortality rate [1]. We aimed to evaluate the predictive role of Tc-99m DMSA cortical scanning in predicting the short term outcome [STO] of the admission period in the intensive care in sepsis-induced ARF patients [SARF]. Sound prognostic data in sepsis induced acute renal failure (SARF) are lacking especially on the short term outcome [STO] in the intensive care unit [ICU]. We addressed the use of Tc-99m DMSA [2,3-dimercaptosuccinicacid] renal cortical imaging as a prognostic tool in SARF. Methods: Forty patients with acute renal failure due to sepsis [age range 15 - 74 years; median 44.5] were subjected for full history taking complete physical examination, routine ICU monitoring, routine laboratory investigations, APACHE II [Acute Physiology and Chronic Health Evaluation] and SOFA [Sequential Organ Failure Assessment] together with Tc-99m DMSA cortical renal scintigraphy. Conclusion: This preliminary data could raise Tc-99m DMSA renal imaging as a prognostic tool in SARF that could allow influential interference to prohibit dramatic outcomes as mortality
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