Nonoliguric Acute Renal Failure Research Articles

Listeria monocytogenes Meningitis Associated with Rhabdomyolysis and Acute Renal Failure

Numerous systemic infections are capable of inducing myositis and rhabdomyolysis. Clinical course of the disease is in the great majority of patients benign and without development of renal dysfunction. However, serious consequences are possible if acute renal failure (ARF) occurs, especially in critically ill patients. Patient with Listeria monocytogenes meningitis associated with rhabdomyolysis and acute non-oliguric ARF is presented. Sixty-nine-year-old white male was admitted to our intensive care unit because of listerial meningitis. The course of the disease was complicated with rhabdomyolysis and non-oliguric ARF. After antimicrobial treatment with parenteral trimethoprim-sulfamethoxazole and 4 days of continuous veno-venous hemodiafiltration (CVVHDF) the patient recovered. We report a case of listerial meningitis complicated with non-oliguric ARF. Rhabdomyolysis should be considered in all patients with infection and increased CK, especially if consciousness is impaired is altered. Furthermore, despite the normal diuresis ARF could be present and result in adverse consequences. We infer that timely diagnosis and treatment should improve the outcome of infection-induced rhabdomyolysis and could prevent a proportion of associated ARF.

Viral haemorrhagic fever and a skin rash-what is the link?

A 38-year-old, previously healthy woman was admitted with non-oliguric acute renal failure. Prior to admission she had a 2-week history of sudden fever with a peak of 40◦C, lower back pain, severe headache, abdominal pain, emesis, increasing faintness and impaired vision. Initially she was admitted to a surgical unit, where the symptoms resolved within 3 days. Physical examination showed a weight gain of 5 kg, oedema of the lower legs and a butterfly rash (Figure 1). She lived in a forest area and regularly collected firewood. Laboratory results are shown in Table 1. A kidney biopsy was performed, which showed the images in Figures 2 and 3a–c.

MECHANISMS OF THE URINARY CONCENTRATION DEFECT AND EFFECT OF DESMOPRESSIN DURING ENDOTOXEMIA IN RATS

Acute renal failure during human sepsis is often nonoliguric. To study the underlying mechanisms, renal function was assessed in endotoxic and control male Wistar rats during and after saline loading and treatment with the selective V2 receptor agonist desmopressin. Escherichia coli endotoxin (dose, 8 mg/kg) was administered from time (t)=0 to t=60 min; saline loading (rate, 5 mL/100 g per hour) was administered from t=0 to t=120 min. Thereafter, half of each group received desmopressin (dose, 10 microg) for 1 h. The inner medullary (IM) osmolality, hematocrit, plasma, and urinary concentrations of sodium, potassium, urea, and osmolality were measured; then, aquaporin 2 (AQP2) immunohistochemistry was performed. Plasma vasopressin concentrations were measured at t=180 min. Saline loading increased urine volume in all rats. In the endotoxic group, mean arterial pressure decreased when saline loading was stopped. Despite increased hematocrit and vasopressin levels (>16 pg/mL), the endotoxin group had a low IM osmolality (mean +/- SEM, 412+/-0.04 mOsm/kg H2O) in comparison with the control group (mean +/- SEM, 1,094+/-0.17 mOsm/kg H2O) and was not able to either decrease urine volume or raise urine osmolality. Desmopressin treatment in endotoxin-treated rats maintained mean arterial pressure, increased sodium reabsorption, IM osmolality, and urine osmolality, and decreased urine flow. The AQP2 intensity decreased in the endotoxin group, and the apical localization disappeared; both were not affected by desmopressin. Our results indicate that endotoxemia in rats acutely diminishes renal urinary concentration capacity and is associated with a decreased IM osmolality and diminished apical AQP2 localization. These findings may help to explain nonoliguric acute renal failure in human septic shock.

Isolated bladder aspergillosis as the primary presentation of non-oliguric acute renal failure

A 70-year-old male patient with diabetes mellitus presented to our hospital with acute obstructive non-oliguric renal failure. Abdominal CT revealed obstructive hydronephrosis and irregular thickening of the bladder wall. Upon cystoscopy, samples of tissue were taken and found to be positive for Aspergillus spp. on histology, indicating infection of the bladder wall. The patient was treated successfully by means of a percutaneous nephrostomy and a 30-day course of caspofungin.

Novel HGPRT 293 A>G point mutation presenting as neonatal acute renal failure

We report on a rare case of hypoxanthine guanine phosphoribosyl transferase (HGPRT) deficiency that presented in the newborn period with acute renal failure (ARF). The clinical diagnosis was made on the basis of non-oliguric ARF and evidence of crystal nephropathy on renal biopsy. HGPRT deficiency was eventually confirmed by enzymatic and genetic testing, showing a novel point mutation, 293 A>G. Immediate treatment consisted of peritoneal dialysis with, initially, lactate- then bicarbonate-buffered 1.36% glucose solution together with oral administration of allopurinol. Follow-up after more than 4 years continued to show hyper-echogenic kidneys with almost normal renal glomerular function. There continues to be no neurobehavioural abnormalities.

Nonsteroidal Anti-inflammatory Drugs and Abdominal Pain

1. David N. Collier, MD, PhD 1. Brody School of Medicine at East Carolina University Greenville, NC 1. Cassie Billings, PharmD 1. Pitt County Memorial Hospital Greenville, NC Acute Renal Failure Associated with Non-Steroidal Anti-Inflammatory Drugs in Healthy Children. Krause I, Cleper R, Einstein B, Davidovits M. Pediatr Nephrol. 2005;20 :1295– 1298[OpenUrl][1][CrossRef][2][PubMed][3] Analgesic-antipyretic and Anti-inflammatory Agents and Drugs Employed in the Treatment of Gout. In: Hardman JG, Limbird LE, Gilman AG, eds. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 10th ed. New York, NY: McGraw-Hill; 2001:687– 731 Non-steroidal Anti-inflammatory Drugs and Exacerbations of Asthma in Children. Body R, Potier K. Emerg Med J. 2004;21 :713– 724[OpenUrl][4][Abstract/FREE Full Text][5] The Effectiveness of Five Strategies for the Prevention of Gastrointestinal Toxicity Induced by Non-steroidal Anti-inflammatory Drugs: Systematic Review. Hooper L, Brown TJ, Elliot RA, et al. BMJ. 2004;329 :948[OpenUrl][6][Abstract/FREE Full Text][7] The Safety of Acetaminophen and Ibuprofen Among Children Younger Than Two Years Old. Lesko SM, Mitchell AA. Pediatrics. 1999;104 :e39[OpenUrl][8][Abstract/FREE Full Text][9] Nonsteroidal anti-inflammatory drugs (NSAIDs) are a chemically heterogeneous group of compounds that have analgesic, antipyretic, and anti-inflammatory properties. These effects are mediated primarily through inhibition of the cyclooxygenase enzymes (COX-1 and COX-2), which are involved in the production of prostaglandins (PGs) and thromboxanes (TXs). The COX-1 isoform is produced constitutively in a variety of tissues and organs, including the kidney, vascular endothelium, and gastric mucosa. In many tissues, expression of the COX- 2 isoform is induced by inflammatory mediators, but COX-2 also is produced constitutively in the brain, uterus, and kidneys. PGI2 and prostaglandins of the E family (PGEs) reduce the pain threshold of nociceptors, resulting in hyperalgia (the sensitization of afferent nerve endings to the effects of mechanical or chemical stimulation). Hence, NSAID-mediated inhibition of PGI2 and PGE synthesis can provide effective analgesia by … [1]: {openurl}?query=rft.jtitle%253DPediatric%2Bnephrology%2B%2528Berlin%252C%2BGermany%2529%26rft.stitle%253DPediatr%2BNephrol%26rft.aulast%253DKrause%26rft.auinit1%253DI.%26rft.volume%253D20%26rft.issue%253D9%26rft.spage%253D1295%26rft.epage%253D1298%26rft.atitle%253DAcute%2Brenal%2Bfailure%252C%2Bassociated%2Bwith%2Bnon-steroidal%2Banti-inflammatory%2Bdrugs%2Bin%2Bhealthy%2Bchildren.%26rft_id%253Dinfo%253Adoi%252F10.1007%252Fs00467-005-1966-x%26rft_id%253Dinfo%253Apmid%252F15973524%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1007/s00467-005-1966-x&link_type=DOI [3]: /lookup/external-ref?access_num=15973524&link_type=MED&atom=%2Fpedsinreview%2F28%2F2%2F75.atom [4]: {openurl}?query=rft.jtitle%253DEmergency%2BMedicine%2BJournal%26rft.stitle%253DEmerg.%2BMed.%2BJ.%26rft.issn%253D1351-0622%26rft.aulast%253DBody%26rft.auinit1%253DR.%26rft.volume%253D21%26rft.issue%253D6%26rft.spage%253D713%26rft.epage%253D714%26rft.atitle%253DNon-steroidal%2Banti-inflammatory%2Bdrugs%2Band%2Bexacerbations%2Bof%2Basthma%2Bin%2Bchildren%26rft_id%253Dinfo%253Adoi%252F10.1136%252Femj.2004.019687%26rft_id%253Dinfo%253Apmid%252F15496704%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [5]: /lookup/ijlink?linkType=ABST&journalCode=emermed&resid=21/6/713&atom=%2Fpedsinreview%2F28%2F2%2F75.atom [6]: {openurl}?query=rft.jtitle%253DBMJ.%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.38232.680567.EB%26rft_id%253Dinfo%253Apmid%252F15475342%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [7]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=329/7472/948&atom=%2Fpedsinreview%2F28%2F2%2F75.atom [8]: {openurl}?query=rft.jtitle%253DPediatrics%26rft.stitle%253DPediatrics%26rft.issn%253D0031-4005%26rft.aulast%253DLesko%26rft.auinit1%253DS.%2BM.%26rft.volume%253D104%26rft.issue%253D4%26rft.spage%253De39%26rft.epage%253De39%26rft.atitle%253DThe%2BSafety%2Bof%2BAcetaminophen%2Band%2BIbuprofen%2BAmong%2BChildren%2BYounger%2BThan%2BTwo%2BYears%2BOld%26rft_id%253Dinfo%253Adoi%252F10.1542%252Fpeds.104.4.e39%26rft_id%253Dinfo%253Apmid%252F10506264%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [9]: /lookup/ijlink?linkType=ABST&journalCode=pediatrics&resid=104/4/e39&atom=%2Fpedsinreview%2F28%2F2%2F75.atom

Clinical and laboratory predictors of oliguric renal failure in haemorrhagic fever with renal syndrome caused by Hantaan virus

Haemorrhagic fever with renal syndrome (HFRS), caused by hantavirus infection, develops into acute renal failure (ARF) of variable degrees of severity. We investigated the early predictive markers for oliguric ARF in HFRS patients. A retrospective cohort study was performed of 61 patients with HFRS between 2000 and 2004. These patients were categorized into either oliguric or non-oliguric ARF groups according to their urine output (<400 ml/24 h). The clinical characteristics were compared between the two groups. Of the 61 patients, 24 (39.3%) were classified as oliguric ARF and 37 (60.7%) as non-oliguric ARF. The peak serum Cr was 10.8 (IQR 9.1-12.4) mg/dl in oliguric ARF and 4.4 (IQR 3.1-6.0) mg/dl in non-oliguric ARF (p<0.001). The risk for developing oliguric ARF significantly increased in the cases with leukocyte count (> or =14 x 10(9)/L, aOR 2.2, 95% CI 1.0-4.9; p=0.039), elevated aspartate aminotransferase (> or =110 U/L, aOR 11.0, 95% CI 2.1-57.9; p=0.005) and the presence of microscopic haematuria (> or =5/HPF, aOR 9.2, 95% CI 1.4-60.3; p=0.021) at the time of admission. The leukocyte count, level of aspartate aminotransferase and microscopic haematuria at admission would be useful to predict for the subsequent development of oliguric ARF in HFRS.

Epidemiology and prognostic factors of critically ill patients treated with hemodiafiltration

Purpose The objective of this study is to study the epidemiology, outcome, and prognostic factors of critically ill patients treated with continuous venovenous hemodiafiltration (CVVHDF). Materials and Methods Observational cohort was done in a French 16-bed intensive care unit (ICU) from a university-affiliated urban hospital. All patients requiring, in the opinion of the treating physician, the initiation of CVVHDF were included in the study. Results One hundred ninety-seven patients with acute renal failure (ARF) treated with CVVHDF were studied. The incidence of ARF treated with CVVHDF was 5.9% in the ICU with a mortality rate of 71.6%. A multivariate analysis identified 3 independent factors associated with fatal outcome: mechanical ventilation, sepsis, and septic shock requiring vasoactive drug. In contrast, 2 independent factors predicted a favorable outcome: nonoliguric ARF and serum creatinine concentration higher than 34 mg/L at CVVHDF initiation. A flowchart determined by the χ 2 Automatic Interaction and Detection statistical method allowed for the identification of patients' subgroups with different mortality rates ranging from 25% to 100%. Conclusions In our series, ARF treated with CVVHDF was associated with a high overall ICU mortality rate (71.6%). However, our prognostic flowchart identified patients with low mortality rates for which renal replacement therapy must be initiated with no discussion as soon as required.

Rhabdomyolysis and acute renal failure following arthroscopic knee surgery in a college football player taking creatine supplements

We describe a college football player and weight-lifter who unexpectedly developed rhabdomyolysis and nonoliguric acute renal failure (ARF) following arthroscopic knee surgery. There was swelling and pain without evidence of a compartment syndrome postoperatively. The patient reported that he was an avid weight-lifter and that he was taking up to 10 g/d of a creatine supplement during the 6 weeks prior to this surgery. His ARF resolved over several days, with a peak serum creatinine of 2.3 mg/dl and peak creatine kinase (CK) of 194,000 U/l, following administration of intravenous fluids, mannitol, and sodium bicarbonate. Given the rarity of clinically significant rhabdomyolysis with this type of operation, we suggest that the patient's use of creatine increased the risk of skeletal muscle injury due to ischemia from intra-operative tourniquet application.

Renal failure associated with Legionella pneumophila infection

A 61-year-old African-American male with a past medical history of hypertension and osteoarthritis was brought to the emergency department for severe dyspnoea and agitation for the past few hours. Family members gave a history of fever, myalgias, anorexia, nausea and a non-productive cough of 3–4 days duration. He also had a several day history of shortness of breath and right-sided pleuritic chest pain. He had a 40-pack a year tobacco history and consumed 1–2 beers every day. He had had no alcohol in the past 4 days. His home medications included amlodipine and ibuprofen. He was currently unemployed. In the emergency department, vitals signs included a temperature of 38.8°C, pulse rate of 118 beats per minute, respiratory rate of 24 breaths per minute, blood pressure of 122/68 mmHg with no orthostatic signs and an oxygen saturation of 89% on 4 litres oxygen by nasal cannula. Physical examination was unremarkable except for intermittent agitation and crackles on auscultation of the right middle and lower lung zones. Laboratory values at admission were as follows: sodium =129 mmol/litre, bicarbonate =23 mmol/litre, blood urea nitrogen = 30.7 mmol/litre, creatinine = 910.5 μmol/litre, total bilirubin =80.4 μmol/litre with an unconjugated fraction of 53 μmol/litre, alkaline phosphatase = 110 U/litre, alanine transaminase = 147 U/litre, aspartate aminotransferase = 234 U/litre, creatine kinase = 7533 U/litre with muscle-brain fraction of 7.48 U/litre, haemoglobin = 129 g/litre, white blood cell count = 10100/mm3 with 43% bands, platelet count = 200 000/mm3, other labs including serum calcium, magnesium, chloride, potassium, phosphate, amylase and lipase were within the normal range. Serum and urine toxicological screens were negative. Electrocardiogram revealed normal sinus rhythm with left ventricular hypertrophy by voltage criteria. Urine dipstick was positive for large amount of blood. Urine microscopy showed 110 red blood cells per high power field. A chest roentgenogram showed a right lower lobe infiltrate. Upon admission, the patient's hypoxaemia worsened and he required bi-level positive airway pressure for ventilation. With a presumptive diagnosis of aspiration pneumonia vs community-acquired pneumonia, piperacillin-tazobactam and azithromycin were instituted. In view of the agitation and the patient's history of alcohol use, he was placed on alcohol withdrawal precautions. Renal service was consulted the following morning for his non-oliguric acute renal failure (urine output = 600 ml over the previous 24 hours). The baseline renal function of this patient was not known. With evidence of multiple organ system involvement including the lungs, liver and kidney, an extensive work-up for vasculitides as well as an infectious aetiology was initiated. Serum complement levels (C3, C4, and CH 50) were within the normal range. Assays for anti-nuclear antibody, anti-double-stranded DNA antibody, anti-neutrophilic cytoplasmic antibodies, anti-glomerular basement membrane antibody as well as serological tests for hepatitis B and C were all negative. Renal failure worsened over the next 3 days and the patient required hemodialysis three times over the next 4days (Figure 1). While all tests including sputum, urine and blood cultures remained negative, the urinary antigen for Legionella pneumophila serogroup 1 was positive. Piperacillin-tazobactam was discontinued and azithromycin was continued to complete a 21-day course. Serum creatinine at discharge was 300.5 μmol/litre. The patient was subsequently lost to follow-up.

Acute renal failure in a pediatric kidney allograft recipient treated with intravenous immunoglobulin for parvovirus B19 induced pure red cell aplasia

Infection with parvovirus B19 (PV-B19) after solid organ transplantation may cause pure red cell aplasia (PRCA). Intravenous immunoglobulin (IVIg) may be of benefit in clearing the infection. Acute renal failure is a known adverse effect of IVIg administration. A 14-yr-old male received a cadaveric renal transplant. Three weeks after surgery he developed symptomatic anemia (hemoglobin 4.5 g/dL, reticulocyte count 0.2%). Anti-PV-B19 IgM and IgG titers, which had been negative pretransplant, were positive. He received two IVIg infusions as treatment for the PV-B19 infection. Four days after the IVIg infusions he developed non-oliguric acute renal failure (ARF) with a rise in serum creatinine from 1 to 1.8 mg/dL. Allograft biopsy showed changes consistent with an osmotic load. Anemia and the renal failure resolved after transfusions and IVIg. PV-B19 infection in immunosuppressed transplant recipients is associated with significant morbidity and may respond to IVIg therapy. High sucrose IVIg preparations may be associated with renal failure in renal allograft recipients. Adding PV-B19 testing of the donor and recipient to the standard pretransplant evaluation may be beneficial in diagnosing and managing a potential infection. If IVIg is to be used it may be safer to use a sucrose-free IVIg preparation.

Acute Renal Failure Management in the Neonate

After completing this article, readers should be able to: 1. Define the types and delineate the causes of acute renal failure (ARF) in neonates. 2. Describe the laboratory tests and imaging studies used to diagnose ARF. 3. Explain the roles of fluid balance, diuretics, dopamine, and nutrition in the management of neonatal ARF. 4. Describe the approaches to treating hyponatremia, hyperkalemia, calcium-phosphorus perturbations, acidosis, and hypertension in ARF. 5. Review the outcome and prognosis for ARF in neonates. Acute renal failure (ARF) is a very common problem in the neonatal intensive care unit. The newborn kidney has a very low glomerular filtration rate (GFR) that is maintained by a delicate balance between vasoconstrictor and vasodilatory forces. (1) Although sufficient for growth and development under normal conditions, the low GFR of the newborn kidney limits postnatal renal functional adaptation to endogenous and exogenous stresses. (2) This limited response predisposes the newborn to the development of ARF and is even more pronounced in the low birthweight infant (ie, <2,500 g due to preterm birth or intrauterine growth restriction). (3) Given this predisposition, early identification of ARF in the neonate is essential to preserving renal function. The true incidence of neonatal ARF is difficult to ascertain, but studies have reported that 8% to 24% of newborns admitted to the neonatal intensive care unit present with ARF. These percentages are likely an underestimation because many cases of nonoliguric neonatal ARF, which occurs commonly in sick neonates, are excluded. (1) ARF is defined as a sudden decrease in GFR that results in the progressive retention of creatinine and nitrogenous waste products and the inability to regulate fluid and electrolyte homeostasis. The definition of ARF in neonates is less precise because the serum creatinine shortly after birth is a reflection of maternal renal function, usually less than 1.0 mg/dL (88.4 …

Precursor B-cell lymphoblastic leukemia as a cause of a bilateral nephromegaly

Nephromegaly and non-oliguric acute renal failure is an unusual manifestation of lymphoblastic infiltration of the kidneys. We report the clinical history of a female child where a precursor B-cell lymphoblastic proliferation was diagnosed at the age of 21 months by a surgical renal biopsy for an unexplained bilateral nephromegaly. Lymphoblastic infiltration should be suspected in any patient presenting with unexplained renal failure and enlarged kidneys. The importance of renal biopsy to identify the etiology of renal failure and nephromegaly is emphasized.

Relationship of Urine Output to Dialysis Initiation and Mortality in Acute Renal Failure

Background: A non-oliguric state is considered a good prognostic indicator in acute renal failure (ARF), and may lead to withholding renal replacement therapy in anticipation of recovery. The present study explores the relationship between urine volume and the start of dialysis and hospital mortality in patients with ARF. Methods: In a non-concurrent cohort of patients with ARF treated exclusively with intermittent hemodialysis (IHD), demographic, clinical and laboratory characteristics were collected at the time of the first nephrology consultation and at the start of dialysis. Multiple linear and logistic regression analyses were used to identify factors associated with the time to initiation of dialysis and hospital mortality, respectively. Results: Urine volume correlated with the time from admission to start of dialysis (r = 0.60; p < 0.001). Higher urine volume, lower serum creatinine and lower APACHE II score were independently associated with increased time from admission to start of dialysis. Hospital mortality was independently associated with a higher urine volume (odds ratio, OR 3.8, 95% confidence interval, CI, 1.1–12.8, p = 0.03), a higher MOF score (OR 4.9, 95% CI 1.1–21.6, p = 0.03) and a higher number of dialysis treatments performed in the 1st week (OR 3.7, 95% CI 1.2–11.3, p = 0.03). Conclusions: Among patients with ARF requiring IHD, increased urine output is associated with higher mortality. This observation may reflect physician bias toward later initiation of dialysis in non-oliguric ARF. Further research is needed to help identify patients with non-oliguric ARF who require early dialytic support.

Pediatric acute renal failure in southwestern Nigeria

Acute renal failure (ARF) was investigated to determine the prevalence of ARF clinical types, etiology, comorbidities, and outcome in Nigerian children. Consecutive cases of ARF admitted from March, 1994 through February, 2003 were prospectively studied. Information were obtained concerning the following: age, gender, body surface area, early (within 48 hours of onset of ARF) or late (>48 hours of onset of ARF) presentation, admission duration, etiology, comorbidities, urine volume/day, dialysis need, reasons for considering dialysis, laboratory investigations, and outcome in each patient. Histopathologic reports of percutaneous renal and surgical biopsies, as well as autopsy specimens, were reviewed. There were 78 boys and 45 girls (M:F, 1.73:1); mean age was 6.28 +/- 4.0 years. A portion of patients presented early (46.3%), while 53.7% presented late. Oliguric (63.41%), anuric (20.33%), and nonoliguric (16.26%) ARF were the clinical types seen. Dialysis requirement was significantly higher in oliguric (P < 0.005) and anuric (P < 0.005) than nonoliguric ARF. Primary and secondary etiologies accounted for 29% and 71% of ARF cases, respectively. Renal Burkitt's lymphoma (47.2%), glomerulonephritis (27.8%), nephrotic syndrome (16.7%), hemolytic uremic syndrome (5.5%), and acute tubulointerstitial nephritis (2.8%) were primary etiologies. Plasmodium falciparum malaria (42.53%), septicemia (28.73%), hypovolemia (11.49%), and obstructive uropathy (8.05%) were major secondary etiologies. Financial constraints on the part of parents of patients, as well as inadequate and/or lack of dialysis equipment, were major inhibitions to effective management of the patients; in fact, 6 patients took voluntary discharge due to inability to afford the cost of treatment. Mortality risk factors were late presentation [odds ratio (OR) 3.5, P < 0.001], dialysis eligibility (OR 3.8, P < 0.001), nondialysis (OR 23.1, P= 0.00004), primary etiology (OR 2.6, P < 0.025), and presence of > or =2 comorbidities (OR 2.9, P < 0.025); overall mortality rate was 46.2%. These results show that many of the causes of ARF in our patients are preventable; it should be possible to reduce morbidity due to ARF through purposive preventive measures.

Acute Renal Failure in the Neonatal Period

Acute renal failure (ARF) is a common problem in the neonatal intensive care unit (NICU). In most cases, ARF is associated with a primary condition such as sepsis, metabolic diseases, perinatal asphyxia and/or prematurity. This retrospective study investigated the course of illness, therapeutic interventions, early prognosis and risk factors associated with development of ARF in the neonatal period. A total of 1311 neonates were treated in our NICU during the 42‐month study period, and 45 of these babies had ARF. This condition was defined as serum creatinine level above 1.5 mg/dL despite normal maternal renal function. The data collected for each ARF case were contributing condition, cause and clinical course of ARF, gestational age and birth weight, age at the time of diagnosis, treatment, presence of perinatal risk factors and need for mechanical ventilation. The frequency of ARF in the NICU during the study period was 3.4%. Premature newborns constituted 31.1% of the cases. The mean birth weight in the group was 2863 ± 1082 g, and the mean age at diagnosis was 6.2 ± 7.4 days. The causes of ARF were categorized as prerenal in 29 patients (64.4%), renal in 14 patients (31.1%) and postrenal in 2 patients (4.4%). Forty‐seven percent of the cases were nonoliguric ARF. Asphyxia was the most common condition that contributed to ARF (40.0%), followed by sepsis/metabolic disease (22.2%) and feeding problems (17.8%). Therapeutic interventions were supportive in 77.8% of the cases, and dialysis was required in the other 22.2%. The mortality rate in the 45 ARF cases was 24.4%. Acute renal failure of renal origin, need for dialysis, and need for mechanical ventilation were associated with significantly increased mortality (p < 0.05). There were no statistical correlations between mortality rate and perinatal risk factors, oliguria, prematurity or blood urea nitrogen and creatinine levels. The study showed that, at our institution, ARF in the neonatal period is frequently associated with preventable conditions, specifically asphyxia, sepsis and feeding problems. Supportive therapy is effective in most cases of neonatal ARF. Acute renal failure of renal origin, need for dialysis, and need for mechanical ventilation were identified as indicators of poor prognosis in these infants. Early recognition of risk factors and rapid effective treatment of contributing conditions will reduce mortality in neonatal ARF.

Acute renal failure due to non-Hodgkin lymphoma infiltration of the kidneys detected by ultrasonography and confirmed by positron emission tomography

Acute renal failure (ARF) as a consequence of non-Hodgkin lymphoma infiltration of the kidneys (LIK) is an uncommon complication of non-Hodgkin lymphoma. In literature, ARF due to LIK is reported in progressive disease. A case of non-oliguric acute renal failure secondary to relapse of large B cell non-Hodgkin lymphoma primarily localized in the mediastinum is reported. LIK of both kidneys was diagnosed by ultrasonography, computer tomography scan and 18-fluorodeoxyglucose positron emission tomography. No other causes for renal failure were found. The prognosis of renal involvement in relapsed non-Hodgkin lymphoma is poor, as is demonstrated by our case.

Acute renal failure in leptospirosis in the black-sea region in Turkey.

Leptospirosis is an infectious disease caused by pathogenic leptospires and is characterized by a broad spectrum of clinical manifestations, varying from inappearent infection to fulminant, fetal disease. Eighty-five to 90% of leptospirosis infections are self-limiting. However, 5-10% of infection by L. interrogans can cause renal tubular damage, microvascular injury, acute renal failure (ARF), and interstitial nephritis. We studied 36 patients with leptospirosis. Twenty-seven (65%) cases of 36 patients had ARF. Fourteen (51%) had nonoliguric ARF. In thirteen (48%) oliguria appeared on the third or fourth days of hospitalization. Serum BUN, creatinine, serum bilirubine, ALT, AST, potassium and thrombocytopenia levels were higher in oliguric than nonoliguric patients (p < 0.05). However, serum sodium, CPK levels were not different between oliguric and nonoliguric groups (p > 0.05). Thirteen patients (48%) needed in renal replacement therapy (RRT). 8 of them were treated by hemodialysis (HD) alone and 5 patients by HD in combination with hemoperfusion. Twenty-five patients (92%) recovered completely after 3-5 weeks. Two patients (7.4%) who had severe hepatorenal and hemorrhagic syndromes, died. We concluded that till now leptospirosis is actual problem for nephrologist in the developing countries because of very high percentage of renal disease, with good prognosis in patients without multiorgan failure and early treatment.

Acute oliguric renal failure in hypoxic neonates born at full term

Acute renal failure (ARF) is a frequent clinical condition in neonatal intensive care units (NICU). The leading cause of neonatal ARF is perinatal asphyxia (PS). The aim of this study was to examine the relationship between the degree of PS and the severity of ARF in term neonates. A prospective survey of 31 term neonates with Ps and but without congenital malformations or sepsis was performed in NICU of the regional Hospital of Gynaecology and Obstetrics in Belgrade (average number of deliveries about 6000 per year). ARF was diagnosed in the first 7 days of life when plasma creatinine was above 133 mumol/L for at least 48 hours while maternal renal function was normal. The degree of PS was determined according to Apgar score (AS) at 1 min. The severe PS was defined as AS < 3 and moderate PS as AS 4-6. Twenty neonates (64%) had oliguric ARF with urine output of 0.37 +/- 0.16 ml/kg/h while the others had nonoliguric ARF with urine output of 2.4 +/- 0.7 ml/kg/h. Most of neonates with oliguric ARF (65%) had severe perinatal asphyxia while in those with nonoliguric ARF moderate perinatal asphyxia predominated (73%). During hypoxic-ischaemic events many organs are injured, and the most vulnerable ones are kidneys and central nervous system. Our results showed a strong connection between perinatal asphyxia and A, which was in accordance with the results of other studies. Neonates with severe perinatal asphyxia had serious impairment of renal function, which was confirmed with strong correlation between Apgar score and plasma creatinine. In neonates with oliguric ARF, but not in those with nonliguric ARF, the highly positive linear correlations were found between AS and urinary output (r = 0.77; p < 0.01), plasma creatinine (r = 0.78; p < 0.01), fractional excretion of sodium (r = 0.76; p < 0.01), and index of renal failure (r = 0.80; p < 0.01). Only in oliguric neonates with severe perinatal asphyxia (31%) the outcome was fatal. We conclude that in tgerm neonates with severe perinatal asphyxia oliguric ARF was the predominant type of ARF. There is a good prediction of the severity of oliguric ARF according to the degree of perinatal asphyxia determined by Apgar score at 1 min.

Celecoxib-Induced Nonoliguric Acute Renal Failure

Celecoxib-Induced Nonoliguric Acute Renal Failure