Predictors Of Acute Renal Failure Research Articles

2022 Canadian Surgery Forum Sept. 15–17, 202201. Operative classification of ventral abdominal hernias: new and practical classification02. Watchful waiting for large primary splenic cysts03. Transversus abdominis plane (TAP) blocks with and without dexamethasone in colorectal surgery04. What factors determine publication of resident research day projects?05. Characterization of near-infrared imaging and indocyanine green use amongst general surgeons06. Variation in opioid prescribing

# 01. Operative classification of ventral abdominal hernias: new and practical classification {#article-title-2} Ventral hernias of the abdomen are defined as a noninguinal, nonhiatal defect in the fascia of the abdominal wall. Unfortunately, there is not currently a universal classification system

Prediction of Acute Renal Failure in Dengue Fever Patients

Background: Dengue virus (DENV) infection is caused by an arboviral strain and is transmitted by the mosquito Aedes aegypti which is found in Sudan especially Red Sea and Kassala states in the east. The disease is known to cause renal disturbances and a thorough understanding of that will potentially help in the prediction, diagnosis and treatment of the disease. Methods: This study is a prospective observational cross sectional study conducted in the Eastern Sudan College of Medical Science and Technology and Port Sudan Teaching Hospital. 200 confirmed Dengue virus infected patients along with 200 healthy appearing adults (control) were enrolled for the study. Statistical analysis was carried out after the collection of patients’ demographic, clinical, and investigational data including serum urea and creatinine values. Ethical approval was obtained from the ministry of health, Red Sea state and informed written consent was obtained from each participant. Results: The highest incidence of DENV infection was observed in individuals of the middle age group (29%). Elevated blood urea levels were detected in 10 (5%) patients while elevated creatinine levels were seen in 17 (8.5%) patients. Although fallen within reference ranges found in the literature, mean blood urea and creatinine values differed significantly between patients and controls and between different categories of the disease. Mean blood urea concentration showed a statistically significant difference between the control (22.3 mg/dl) and the test (28.4 mg/dl) (P value < 0.001). Similarly, mean serum creatinine in the control (0.70 mg/dl) differed significantly (P value < 0.001) from test (0.94 mg/dl). Clinically, fever was present in 97.5% of patients, headache in 95.5%, joints pain in 71%, lethargy in 67%, vomiting in 49%, skin rash in 40%, abdominal pain in 24% and bleeding in 17.5%. Conclusion: We strongly conclude that renal involvement is not uncommon in Dengue fever and that blood urea and creatinine evaluation should be considered in the counseling of DENV infection patients. Patients need to be subjected to necessary laboratory investigations associated with acute kidney injury to decrease the rate of morbidity and mortality associated with the disease.

Urinary Microalbuminuria and Malondialdehyde as Early Predictors of Acute Renal Failure in Adult Thermal Burn Patients

Urinary Microalbuminuria and Malondialdehyde as Early Predictors of Acute Renal Failure in Adult Thermal Burn Patients

In-hospital outcomes after transcatheter edge-to-edge mitral valve repair in patients with chronic kidney disease: An analysis from the 2010-2016 National inpatient sample.

To assess the outcomes following transcatheter edge-to-edge mitral valve repair (TMVr) in patients with chronic kidney disease (CKD). Percutaneous TMVr is beneficial in high surgical risk patients with severe mitral regurgitation (MR). However, those with CKD are not well studied. Utilizing the International Classification of Disease (ninth and tenth revision, clinical modification codes) and the Nationwide Inpatient Sample database, we identified 9,228 patients who underwent TMVr during 2010-2016, including those with no or mild CKD (group 1, n=6,654 [72.11%]), moderate or severe CKD (group 2, n=2,125 [23.03%]) and end-stage renal disease (ESRD) on dialysis (group 3, n=449 [4.86%]). In-hospital clinical outcomes, length of stay and cost were assessed. In-hospital mortality increased numerically as CKD severity increased, but not statistically different between groups (1.8, 3.3, and 4.5% respectively in group 1, 2, and 3, p= .07). Moderate to severe CKD (group 2) was an independent predictor of acute renal failure requiring hemodialysis (ARFD) (OR: 3.51, CI: 2.33-5.28, p < .0001), the composite outcome of death, ARFD or stroke [OR: 3.15, 95% CI: 2.10-4.76, p < .0001] and extended length of stay [OR: 1.73, 95% CI: 1.24-2.42), p=.001] while ESRD (group 3) was an independent predictor of higher hospital cost [OR: 1.66, 95% CI: 1.01-2.74), p=.04] as compared with no or mild CKD (group 1). High surgical risk patients with severe MR commonly have associated comorbidities including CKD. TMVr outcomes appear to worsen with worsening CKD and therefore careful clinical case selection and further studies evaluating TMVr outcomes in CKD patients is warranted.

Machine learning for the prediction of acute kidney injury and paraplegia after thoracoabdominal aortic aneurysm repair.

Prediction of acute renal failure (ARF) and paraplegia after thoracoabdominal aortic aneurysm repair (TAAAR) is helpful for decision-making during the postoperative phase. To find a more efficient method for making a prediction, we performed tests on the efficacy of different machine learning predicting models. Perioperative TAAAR data were retrospectively collected from Beijing Anzhen Hospital and Shanghai DeltaHealth Hospital. Operations were conducted under normothermia using a four-branched graft. Four commonly used machine learning classification models (ie, logistic regression, linear and Gaussian kernel support vector machine, and random forest) were chosen to predict ARF and paraplegia separately. The efficacy of the models was validated by five-fold cross-validation. From 2009 to 2017, 212 TAAARs were performed. ARF was identified in 27 patients, and paraplegia was found in 18 patients. Five-fold cross-validation showed that among the four classification models, random forest was the most precise model for predicting ARF, with an average area under the curve (AUC) of 0.89 ± 0.08. Linear support vector machine was the most precise model for predicting paraplegia, with an average AUC of 0.89 ± 0.18. The prediction program has been uploaded to GitHub for open access. Machine learning models can precisely predict ARF and paraplegia during early stages after surgery. This program allows cardiac surgeons to address complications earlier and may help improve the clinical outcomes of TAAAR.

Pre-operative and peri operative predictors of acute renal failure after cardiac surgery

Background: Acute kidney injury (AKI) is one of the most serious complications during the postoperative period of cardiac surgery. Multiple variables predict the ARF after cardiac surgery. Objective of this study was to evaluate the significance of pre and peri-operative variables which may help in predicting the chances of developing ARF after cardiac surgery.Methods: This study was an observational, prospective study conducted among patients who were scheduled to undergo open heart surgery under cardiopulmonary bypass.Results: In total, 50 patients who underwent open-heart surgery, ARF was seen in 5 patients, with the incidence rate of 10%. Acute renal failure was present in one patient with ejection fraction &lt;35, 2 patients had ejection fraction between 35 to 50 and 2 patients with ejection fraction &gt;50. It was seen in 4 patients with 1-2 hrs of cardiopulmonary bypass and in 1 patient with &gt;2 hrs of cardiopulmonary bypass. ARF was also seen in 4 patients with hematocrit between 22-26% and in 1 patient with &gt;26%.Conclusions: The study provided a clinical variable score that can predict ARF after open-heart surgery. The score enhances the accuracy of prediction by accounting for the effect of all major risk factors of ARF.

Evaluation of Renal Function in Patients Undergoing Lung Transplantation

BackgroundAcute kidney injury and chronic kidney failure are serious complications after lung transplantation. Glomerular filtration rate (GFR) is the primary indicator of renal function. Several equations have been proposed to evaluate the estimated GFR (eGFR). We compared three different equations to determine which has the better correlation with the development of acute and chronic renal failure in lung recipients. MethodsTwenty-two patients with a mean age of 54.4 ± 8.5 years underwent lung transplantation from 2010 to 2015. Thirteen (59%) had pulmonary fibrosis, 7 (32%) emphysema, 1 (4.5%) bronchiectasis, and 1 (4.5%) lymphangioleiomyomatosis. In all patients, eGFR was measured preoperatively using Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and Levey's Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. In 20 patients (90%) eGFR was calculated at 1, 3, and 6 months. ResultsAccording to CKD-EPI and MDRD, eight patients (36.3%) had preoperative reduction in eGFR, whereas 6 patients (27.2%) had preoperative reduction according to the CG (P = .04). The mean values were higher for the CG (103.2 vs. 102 vs. 94.4). Five patients (22.7%) developed perioperative acute renal failure requesting a dialysis treatment; four of these showed a preoperative eGFR to the highest CG (P = .05). At 1 and 6 months after lung transplantation, the CG, MDRD and CKD-EPI eGFR values were, respectively, 86.6, 84.1 and 76.6 mL/min/1.73m2 and 75.8, 72.7, and 72.3 mL/min/1.73m2. CKD-EPI eGFR values are more predictable than the other equations of AKI. ConclusionsPreoperative assessment of eGFR using the MDRD and CKD-EPI seems to correlate better than the CG to the prediction of acute renal failure, whereas for the chronic form the three equations seem equivalent.

Plasma Free Hemoglobin Is a Predictor of Acute Renal Failure During Adult Venous-Arterial Extracorporeal Membrane Oxygenation Support.

Hemolysis is a common and severe complication during extracorporeal membrane oxygenation (ECMO). Increased plasma free hemoglobin (PFHb) is related to renal injury. The aim of this study was to investigate whether increased PFHb during adult venous-arterial ECMO was associated with acute renal failure (ARF). A retrospective, observational, single-center study. Fuwai Hospital in Beijing, China. The study comprised 84 venous-arterial ECMO patients. None. A total of 84 consecutive adult patients (≥18 years) with cardiac diseases requiring venous-arterial ECMO support were studied retrospectively. Demographics of patients, clinical and ECMO characteristics, and PFHb level were collected within the first 3 days after ECMO. ARF was defined as a≥300% rise in serum creatinine from baseline or application of dialysis. Repeated measurement analysis of variance revealed that the main effect for the non-ARF group and ARF group in PFHb (p = 0.002) was significant. A significant main effect for time points (p<0.001) and time×group interaction (p = 0.014) in PFHb was obtained. In a multiple logistic regression model, peak PFHb during ECMO (odds ratio 1.052, 95% confidence interval 1.016-1.089, p = 0.005) was a risk factor for ARF during ECMO and patients who underwent heart transplantation (odds ratio 0.240, 95% confidence interval 0.060-0.964, p = 0.044) experienced less ARF. There was a linear correlation between peak serum creatinine and peak PFHb (Spearman's r = 0.223, p = 0.042). Increased PFHb is a predictor of ARF among adult patients on venous-arterial ECMO support.

Predictors of Acute Renal Failure During Extracorporeal Membrane Oxygenation in Pediatric Patients After Cardiac Surgery.

Acute renal failure (ARF) is associated with increased mortality in pediatric extracorporeal membrane oxygenation (ECMO). The aim of this study was to identify predictors of ARF during ECMO in pediatric patients after cardiac surgery. A retrospective study analyzed 42 children (≤15 years) after cardiac surgery requiring venous-arterial ECMO between December 2008 and December 2014 at Fuwai Hospital. ARF was defined as ≥300% rise in serum creatinine (SCr) concentration from baseline or application of dialysis. Multivariate logistic regression was performed to identify the predictors of ARF during ECMO. A total of 42 children (age, interquartile range [IQR], 13.0 [7.2-29.8] months; weight, IQR, 8.5 [6.7-11.0] kg) after cardiac surgery requiring ECMO were included in this study. The total survival rate was 52.4%, and the incidence of ARF was 40.5%. As the result of univariate analysis, ECMO duration, cardiopulmonary resuscitation, maximum free hemoglobin (FHB) during ECMO, lactate level, and mean blood pressure before initiation of ECMO were entered in multiple logistic regression analysis. In multiple logistic regression analysis, FHB during ECMO (OR 1.136, 95% CI 1.023-1.261) and lactate level before initiation of ECMO (OR 1.602, 95% CI 1.025-2.502) were risk factors for ARF during ECMO after pediatric cardiac surgery. There was a linear correlation between maximum SCr and maximum FHB (Pearson's r = 0.535, P = 0.001). Maximum SCr during ECMO has also a linear correlation with lactate level before initiation of ECMO (Pearson's r = 0.342, P = 0.044). Increased FHB during ECMO and high lactate level before initiation of ECMO were risk factors for ARF during ECMO in pediatric patients after cardiac surgery.

Impact of Acute Renal Failure on In-Hospital Outcomes Following Percutaneous Treatment of Acute Myocardial Infarction

ABSTRACT Background Acute renal failure (ARF) is a possible complication after percutaneous coronary intervention (PCI). The objective of this study was to evaluate the occurrence and prognostic impact of ARF after PCI in patients with ST segment elevation myocardial infarction (STEMI). Methods Single-center registry evaluating in-hospital outcomes of 501 patients admitted with STEMI undergoing primary, rescue or late PCI. The incidence and predictors of ARF after PCI were evaluated. Results Mean age was 60.7 ± 12.6 years and 67% were male. The populaton had high cardiovascular risk characteristics, with 30% of diabetics and 7.4% with preexisting chronic kidney disease (CKD). The left anterior descending artery was the culprit vessel in 49.4% of the cases and 15% of patients had Killip class III or IV. ARF was observed in 24.7% of patients, who were significantly older, had more diabetes, history of CKD or heart failure, had higher enzyme elevation and lower ejection fraction when compared to those without ARF. In-hospital mortality was higher in patients who developed ARF (29% vs. 4.8%; P 76 years, previous CKD, Killip class III or IV, need of vascular surgery or blood transfusion. Conclusions Acute renal failure after PCI in STEMI was a frequent complication and was associated with increased in-hospital mortality.

Coronary Artery Bypass Grafting: 30-Day Operative Morbidity Analysis in 1046 Patients

BackgroundTo determine the rate and risk factors of three operative complications (renal failure, pneumonia, and sternal wound infection) within 30 days after isolated coronary artery bypass surgery.MethodsMedical records of 1,046 consecutive patients between the years 2005 and 2009 were reviewed. Demographic data and peri-operative information were collected and analyzed. Univariate and multivariate analysis between different variables were performed.ResultsOf all patients 3.6% developed pneumonia, 5.9% developed acute renal failure and 8.5% developed sternal wound infection. Independent predictors of acute renal failure were age > 65 years (P = 0.030), pre-operative renal impairment (P < 0.005), peripheral vascular disease (P = 0.005), emergency surgery (P = 0.043), blood transfusion (P = 0.002) mechanical ventilation > 12 hours (P < 0.005) and prolonged inotropic support (P = 0.035). Pneumonia independent predictors were female gender (P < 0.005), diabetes mellitus (P = 0.024), peripheral vascular disease (P = 0.012), emergency surgery (P = 0.007), blood transfusion (P = 0.001), mechanical ventilation > 12 hours (P = 0.005) and prolonged inotropic support (P < 0.005). Sternal wound infection independent predictors were diabetes mellitus (P = 0.017), intra- and post-operative blood transfusion (P < 0.005), and prolonged inotropic support (P = 0.006).ConclusionAge, female gender, history of diabetes mellitus, chronic obstructive pulmonary disease, peripheral vascular disease, renal impairment, emergency surgery, per-operative blood transfusion, mechanical ventilation > 12 hours and prolonged inotropic support are associated with the 30-day complication after on-pump isolated coronary artery bypass grafting surgery.

Acute renal failure predictors in elderly patients with chronic kidney disease.

Acute renal failure (ARF) is a very common problem in the elderly and is associated with high morbidity and mortality rates. This study analysed ARF predictors in a cohort of elderly subjects and their impact on the evolution of renal function. A group of 80 elderly individuals were recruited between January and April 2006, and 56 of these who were still alive after 36 months were retrospectively studied, examining episodes of ARF, their causes, and the need for dialysis. Twelve patients (21.4%) developed ARF: 4 (33.3%) related to heart failure, 4 (33.3%) due to infection/sepsis, 2 (16.7%) due to volume depletion, and another 2 were multifactorial (16.7%). No patients required dialysis therapy. Patients with ARF were older (P=.017), had worse renal function at baseline (P=.031), higher levels of uric acid (P=.002), and lower haematocrit (P=.003). Patients with ARF had a mean baseline serum creatinine of 1.57 ± 0.59 mg/dl and peak creatinine levels during episodes of ARF averaged 4.25 ± 4.26 mg/dl (P=.035). Mean renal function at 36 months in patients with ARF had decreased (P=.024). In a logistic regression analysis (independent variables: baseline MDRD, age, gender, Charlson index, serum creatinine, urea, and uric acid), age (RR: 1.20, 1.01-1.43, P=.039), uric acid (RR: 2.65, 1.11-6.30, P=.027), and haematocrit (RR: 0.64, 0.43-0.96, P=.031) were independently associated with the development of ARF. Baseline levels of uric acid and haematocrit are independent risk factors for the development of ARF in the elderly. Although these episodes may be functional in nature and not require dialysis, this can still cause a deterioration of renal function over time.

Utility of Urine Myoglobin for the Prediction of Acute Renal Failure in Patients with Suspected Rhabdomyolysis: A Systematic Review

Utility of Urine Myoglobin for the Prediction of Acute Renal Failure in Patients with Suspected Rhabdomyolysis: A Systematic Review

Utility of Urine Myoglobin for the Prediction of Acute Renal Failure in Patients with Suspected Rhabdomyolysis: A Systematic Review

Urine myoglobin continues to be used as a marker of rhabdomyolysis, particularly to assess risk of developing acute renal failure and evaluate treatment success. We sought to determine the predictive validity of urine myoglobin (uMb) for acute renal failure (ARF) in patients with suspected rhabdomyolysis. We performed a broad systemic review of the literature from January 1980 to December 2006 using the search terms myoglobin$ AND (renal OR ARF OR kidney). Only primary studies published in English where uMb measurement was related to ARF were included. Of 1602 studies screened, 52 met all selection criteria. The studies covered a wide spectrum of etiologies for rhabdomyolysis, dissimilar diagnostic criteria for ARF and rhabdomyolysis, and various methods of uMb measurement and were mostly case series (n = 32). There was poor reporting on the uMb method, and 17 studies failed to provide any information about the method. The reporting of clinical criteria for ARF with respect to timing, description, performance, and interpretation also lacked adequate detail for replication. Eight studies (total 295 patients) had data for 2-by-2 tables. Sensitivity of the uMb test was 100% in 5 of the 8 studies, specificity varied widely (15% to 88%), and CIs around these measures were high. Pooling of data was not possible because of study heterogeneity. There is inadequate evidence evaluating the use of uMb as a predictor of ARF in patients with suspected rhabdomyolysis.

Markers of Tubular and Glomerular Injury in Predicting Acute Renal Injury Outcome in Thermal Burn Patients: A Prospective Study

Background/aim. Thermal injury elicits several systemic consequences. Acute renal failure (ARF) is a well-known complication of severe burn and is an important factor leading to an increase in mortality. We aimed to focus on early diagnosis of acute renal failure occurring in major burns and to determine the predictors for acute renal failure. Subjects and methods. Forty patients with moderate to severe thermal burn injury—second- to third-degree with >20% of total body surface area—constituted the material of our study. The following parameters were recorded: age, sex, cause of the burn injury, burn surface of second and third degrees expressed as total body surface area burned in %, and Apache II score. All patients were subjected to routine investigations, including serum creatinine, blood urea nitrogen, fractional excretion of sodium, urinary malondialdehyde and microalbuminuria, completed on days 0, 3, 7, 14 and 21. Results. Nine patients (22.5% of all cases) developed acute renal failure, and four patients required supportive dialysis. The group that developed ARF showed rising markers of glomerular damage with appearance of microalbuminuria on day 0 that was maximal (3–4 times its normal level) at day 14 and constant with elevated serum creatinine, as well as burn size in the third week that progressed to overt proteinuria in three cases. Urinary malondialdehyde was also elevated before developing acute renal failure about three times their normal values, gradually increasing on day 14, associated with rising microalbuminuria followed by its decrease after controlling of septicemia. Two cases (22.2%) in ARF group who developed septicemia and required dialysis died on the 32nd and 36th days post-burn. Burn size and occurrence of septicemia were the only predictors of acute renal failure using multiple regression analysis (SE B 0.003 and 0.104; p value of 0.001 and .0371, respectively). Conclusions. Acute renal failure, which complicates 22.5% of burn patients, was found to be related to the size and depth of burn. Microalbuminuria and urinary malondialdehyde are useful markers for prediction of renal outcome in such group of patients. In our study. burn size and septicemia proved to be the only clinical parameters that predict renal outcome.

Abstract 2275: The Association of Cardiac Catheterization Timing, Contrast Media Amount, and Preoperative Renal Function with Post Cardiac Surgery Acute Renal Failure and Mortality

Background The effect of cardiac catheterization timing, contrast media dose, and preoperative renal function on post cardiac surgery acute renal failure (ARF) prevalence is unclear. Methods and Results Data of 395 consecutive patients who underwent CABG were prospectively collected. Glomerular filtration rate (eGFR) was estimated by the CockcroftGault equation. Patients were divided into 3 groups according to the time between cardiac catheterization and surgery (Group I:≤1 day, Group II:&gt;1 and ≤5 days, Group III:&gt;5 days). Patients who underwent salvage operation, or were on dialysis before surgery were excluded. Multivariable analysis was used to identify risk factors for ARF (defined as 25% decrease from baseline of eGFR, and eGFR≤60ml/min on postoperative day 3). propensity score analysis was used to adjust differences in preoperative characteristics between groups. ARF developed in 13% of patients. Hospital mortality was 3.3% and was higher in patients who developed ARF (21%) vs those that did not (0.6%, p&lt;0.001). Multivariable analysis identified operation within 24 hours of catheterization (OR=4), and eGFR&lt;60ml/min up to 5 days from catheterization (OR=2.5) as independent predictors of ARF (p&lt;0.05). The use of more than 1.4 ml/kg of contrast media in patients with eGFR&lt;60ml/min predicted ARF as well (OR=5, p&lt;0.001). Older age, lower weight, and lower preoperative hemoglobin levels were also associated with ARF. Conclusions Whenever possible, cardiac surgery should be delayed for at least 24 hours (preferably 5 days) from catheterization, especially in patients with low eGFR, and in those who received high dose of contrast media.

Development of a risk stratification model for predicting acute renal failure in orthotopic liver transplantation recipients*

The purpose of this prospective observation cohort study was to develop and validate a risk stratification model for prediction of acute renal failure after liver transplantation. Data from 71 orthotopic liver transplantation recipients were used to develop a risk stratification model by binary logistic regression analysis containing the following variables: pretransplant hepatitis B and/or C infection; arterial hypertension; intra-operative mean arterial blood pressure before induction of anaesthesia; units of packed red blood cells required; hypotension (mean arterial blood pressure <or=50 mmHg); and maximum lactate concentration. Validation of the model on 167 consecutive patients revealed a sensitivity of 0.78, a specifity of 0.92, a negative predictive value of 0.96 and a positive predictive value of 0.62. This risk stratification model enables identification of orthotopic liver transplantation recipients with no or low risk for acute renal failure directly at the end of the transplantation procedure.

MARKERS OF TUBULAR AND GLOMERULAR INJURY IN PREDICTING RENAL OUTCOME IN THERMAL BURN PATIENTS

Aim: Thermal injury elicits several systemic consequences. Acute renal failure (ARF) is a well known complication of severe burn and is an important factor leading to an increase in mortality. We aimed to focus on early diagnosis of acute renal failure occurring in major burns and to determine the predictors for acute renal failure. Methods: Forty patients with moderate to severe thermal burn injury - second to third degree with >20% of total body surface area - constituted the material of our study. The following parameters were recorded: Age, sex, cause of the burn injury, burn surface of second and third degrees expressed as total body surface area burned in %, Apache II score. All patients were subjected to routine investigations including: Serum creatinine, blood urea nitrogen, fractional excretion of sodium, urinary malondialdehyde and microalbuminuria were done on day 0, 3, 7, 14 and 21. Results: Nine patients (22.5 % of all cases) - developed acute renal failure, 4 patients required supportive dialysis. The group that developed ARF showed rising of markers of glomerular damage with appearance of microalbuminuria on day 0, that was maximal (3 - 4 folds of its normal level ) at day 14 and constant with elevated serum creatinine and burn size in the 3rd week and progressed to overt proteinuria in 3 cases. Urinary malondialdehyde was also elevated before developing acute renal failure about 3 folds their normal values, gradually increasing on day 14 associated with rising of microalbuminuria followed by their decrease after controlling of septicemia. Two cases (22.2%) in ARF group who developed septicemia and required dialysis died on the 32nd and 36th days post-burn. Burn size and occurrence of septicemia were the only predictors of acute renal failure using multiple regression analysis, (SE B 0.003 and 0.104- P value 0.001 and .0371 respectively). Conclusion: Acute renal failure complicates 22.5 % of burn patients that was found to be related to the size and depth of burn. Microalbuminuria and urinary malondialdehyde are useful markers for prediction of renal outcome in such group of patients. In our study burn size and septicemia proved to be the only clinical parameters that predict renal outcome.

Predictors of Postoperative Acute Renal Failure after Noncardiac Surgery in Patients with Previously Normal Renal Function

The authors investigated the incidence and risk factors for postoperative acute renal failure after major noncardiac surgery among patients with previously normal renal function. Adult patients undergoing major noncardiac surgery with a preoperative calculated creatinine clearance of 80 ml/min or greater were included in a prospective, observational study at a single tertiary care university hospital. Patients were followed for the development of acute renal failure (defined as a calculated creatinine clearance of 50 ml/min or less) within the first 7 postoperative days. Patient preoperative characteristics and intraoperative anesthetic management were evaluated for associations with acute renal failure. Thirty-day, 60-day, and 1-yr all-cause mortality was also evaluated. A total of 65,043 cases between 2003 and 2006 were reviewed. Of these, 15,102 patients met the inclusion criteria; 121 patients developed acute renal failure (0.8%), and 14 required renal replacement therapy (0.1%). Seven independent preoperative predictors were identified (P < 0.05): age, emergent surgery, liver disease, body mass index, high-risk surgery, peripheral vascular occlusive disease, and chronic obstructive pulmonary disease necessitating chronic bronchodilator therapy. Several intraoperative management variables were independent predictors of acute renal failure: total vasopressor dose administered, use of a vasopressor infusion, and diuretic administration. Acute renal failure was associated with increased 30-day, 60-day, and 1-yr all-cause mortality. Several preoperative predictors previously reported to be associated with acute renal failure after cardiac surgery were also found to be associated with acute renal failure after noncardiac surgery. The use of vasopressor and diuretics is also associated with acute renal failure.

Nefropatía inducida por contraste y fracaso renal agudo tras cateterismo cardiaco urgente: incidencia, factores de riesgo y pronóstico

The aim was to investigate the incidence and prognosis of, and predictive factors for, acute renal failure following emergent cardiac catheterization. The study involved 602 consecutive patients who underwent emergent cardiac catheterization. Acute renal failure (ARF) was defined as an increase in serum creatinine level > or =0.5 mg/dL within 72 hours following the procedure. Predictive factors for and the prognosis of ARF were evaluated in an initial cohort of 315 patients, and a risk score was derived. The risk score was validated in a second cohort of 287 patients. The median (interquartile) follow-up time was 1.3 years (0.8-2.0 years). Seventy-two of the 602 patients (12.0%) developed ARF. In the initial cohort of 315 patients, the following factors were predictors of ARF: cardiogenic shock at admission (odds ratio [OR] 4.56), diabetes mellitus (OR 2.98), time to reperfusion >6 hours (OR 3.18), anterior myocardial infarction (OR 2.61), baseline serum creatinine level > or =1.5 mg/dL (OR 3.51), and baseline serum urea level > or =50 mg/dL (OR 3.00). A risk score based on these variables was constructed in which cardiogenic shock = 3 points and each of the remaining variables = 2 points. Patients in the validation cohort were divided into five risk categories: in those with 0 points, the incidence of ARF was 1.2%; with 2-3 points, 8.7%; with 4-5 points, 12.5%; with 6-7 points, 46.2%; and with > or =8 points, 66.7% (P< .0001). Cox regression analysis showed that ARF was a powerful predictor of total mortality (hazard ratio [HR] 5.97, 95% confidence interval [CI] 2.54-14.03; P< .0001) and of a major cardiovascular event (HR 3.29, 95% CI 1.61-6.75; P=.001). The incidence of ARF after emergent cardiac catheterization is high. Cardiogenic shock, diabetes mellitus, myocardial infarction location, time to reperfusion, and serum creatinine and urea levels are predictors of ARF. Patients who developed this complication had higher mortality and major cardiovascular events rates.