SEARCH · PubMed Health

Results for “ACUTE RENAL FAILURE”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources

PubMed2000

Acute renal failure.

Acute renal failure occurs in 5 percent of hospitalized patients. Etiologically, this common condition can be categorized as prerenal, intrinsic or postrenal. Most patients have prerenal acute renal failure or acute tubular necrosis (a type of intrinsic acute renal failure that is usually caused by ischemia or toxins). Using a systematic approach, physicians can determine the cause of acute renal failure in most patients. This approach includes a thorough history and physical examination, blood tests, urine studies and a renal ultrasound examination. In certain situations, such as when a patient has glomerular disease, microvascular disease or obstructive disease, rapid diagnosis and treatment are necessary to prevent permanent renal damage. By maintaining euvolemia, recognizing patients who are at increased risk and minimizing exposure to nephrotoxins, physicians can decrease the incidence of acute renal failure. Once acute renal failure develops, supportive therapy is critical to maintain fluid and electrolyte balances, minimize nitrogenous waste production and sustain nutrition. Death is most often caused by infection or cardiorespiratory complications.

Acute Kidney Injury↗

PubMed2003

Scrub typhus: a frequently overlooked cause of acute renal failure.

Acute renal failure associated with scrub typhus infection is not rare as previously thought. The possibility of scrub typhus should be borne in mind when patients present with fever and varying degrees of acute renal failure, particularly if an eschar exists, along with a history of environmental exposure in an area like Taiwan, where scrub typhus is endemic. Prompt diagnosis and the use of appropriate antibiotics can rapidly alter the clinical course of the disease and prevent the development of serious or fatal complications. To illustrate the above point, this study reports 3 cases of scrub typhus associated with acute renal failure. They were seen at Chang Gung Memorial Hospital in a 2-year interval. Case 1 was referred from district hospital with clinical features of multiple organ dysfunctions, including shock, fever, acute respiratory failure, acute renal failure, and acute hepatitis. Case 2 was admitted with the chief problems of shock, fever, acute renal failure, and DIC. Case 3 visited our outpatient clinic due to fever, maculopapular rash and acute renal failure. In all these patients, the diagnosis was confirmed using immunofluorescence techniques, which showed that Orientia tsutsugamushi had an IgM titer of 1:80 or greater. Notably, despite having varying degrees of acute renal deterioration, the patients responded very well to doxycycline therapy and recovered completely. Additionally, a total of 4 similar cases of scrub typhus associated with acute renal failure were reviewed from the past literature.

Acute Kidney Injury↗

PubMed2001

Dialytic support in acute renal failure.

Acute renal failure is the sudden failure on the part of the kidney to maintain normal biochemical homeostasis in the body. Medical causes of acute renal failure are fluid and electrolyte depletion, infectious diarrhoea, non-diarrhoeal infections, glomerulonephritis, poisoning with heavy metals, G-6-PD deficiency, snake bite and nephrotoxic drugs. Septic abortion is the most common cause of obstetric acute renal failure. Obstructive uropathy is an important cause of surgical acute renal failure. Guidelines to non-dialytic management of acute renal failure depend on the patient's condition which includes volume status, hyperkalaemia, acidaemia, uraemia and whether he/she is receiving medication and having adequate nutrition. Several dialytic methods are currently available for renal replacement therapy--intermittent haemodialysis and peritoneal dialysis are to name a few. Dialytic intervention in acute renal failure is usually considered when there is dinical evidence of uraemic symptoms or biochemical features of solute and fluid imbalance. Continuous renal replacement therapy implies to continuous replacement of renal function and it is limited to only a few big centres.

Acute Kidney Injury↗

PubMed2002

Acute renal failure.

Acute renal failure is characterized by an increase in the blood concentration of creatinine and nitrogenous waste products and by the inability of the kidney to appropriately regulate fluid and electrolyte homeostasis. There are many different causes of acute renal failure in children, including prerenal disease, intrinsic renal failure, which includes ischemic hypoxic insults, and obstructive uropathy. This review will focus on hypoxic/ischemic acute renal failure, the most common causes of hospital acquired acute renal failure in children. This review will briefly discuss the epidemiology and incidence of acute renal failure in pediatric patients and review new insights into the pathogenesis of acute renal failure. including hemodynamic alterations induced by alterations in nitric oxide and endothelin metabolism, the role of the inflammatory response, and alteration in polarity in the acute renal failure. The therapy of acute renal failure has changed substantially during the past few years. Controlled trials (in adults) to test the efficacy of "renal dose" dopamine have shown that it is ineffective, and hemofiltration has become increasingly popular as a choice of therapy for acute renal failure.

Acute Kidney Injury↗

PubMed2000

Dialytic care of patients with acute renal failure.

Acute renal failure remains a common and life-threatening disease with a very high mortality. Renal replacement therapy only provides supportive care. The purpose of this review is to discuss the indications and complications of renal replacement therapies in acute renal failure. Various controversial issues such as biocompatibility of membranes, adequacy of dialysis and utilization of continuous renal replacement therapies in acute renal failure are also covered. The nutritional needs of a patient with acute renal failure receiving renal replacement therapy are also explained. Finally, the outcome of patients with acute renal failure requiring dialysis is discussed.

Journal Article↗

PubMed2000

Unusual presentation of mesangial proliferative glomerulonephritis in HELLP syndrome associated with acute renal failure.

Acute renal failure in pregnancy is not common in industrialized countries. HELLP syndrome (hemolysis, elevated liver enzyme, and low platelets) was one of the causes of acute renal failure in pregnancy, but renal pathological findings in case of acute renal failure had rarely been reported. We reported an unusual case of HELLP syndrome with acute renal failure requiring renal replacement therapy and which histopathologic findings of kidney biopsy showed mesangial proliferative glomerulonephritis and her renal function completely recovered after immediate artificial abortion, supportive management, transfusion of blood products, and hemodialysis.

Abortion, Therapeutic↗

PubMed1991

Community-acquired acute renal failure.

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 mumol/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 mumol/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.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗

PubMed1997

Management of the critically ill pediatric patient with acute renal failure.

Acute renal failure in the critically ill child can be a devastating and sometimes fatal event. Pediatric critical care nurses assume significant responsibility for early recognition, prevention, and treatment of children who develop acute renal failure. Knowledge of renal anatomy and physiology, developmental risk factors, nursing and medical management strategies, and renal replacement therapies is necessary for the delivery of competent care. This article explores the precipitating causes and complications of acute renal failure, prevention strategies, diagnosis and management, continuous renal replacement therapies, and the nurse's role in each. Furthermore, consideration is given to future treatments for acute renal failure.

Acute Kidney Injury↗

PubMed1997

Posttransplant acute renal failure.

Acute renal failure posttransplant is a multifactorial syndrome in the early phases of transplantation. Delayed graft function is common and confers an adverse prognosis for both short- and long-term survival of the renal allograft. Later out from transplantation, the differential diagnosis of acute renal failure is usually between acute renal failure secondary to rejection or cyclosporine nephrotoxicity. Transplant biopsies are often needed to distinguish these possibilities.

Acute Kidney Injury↗

PubMed1998

Treatment of acute renal failure.

Acute renal failure is a life threatening illness whose mortality has remained high since the introduction of hemodialysis 25 years ago, despite advances in supportive care. Acute renal failure is an extremely morbid and costly disorder with a significant proportion of patients progressing to end-stage renal disease requiring dialysis. To the nephrologist, acute renal failure remains an extremely frustrating disease, because the pathophysiology is not well understood and the limited therapeutic options force the nephrologist to sit on the sidelines and wait for renal function to return. For example, dialysis remains the only FDA-approved treatment for acute renal failure, but dialysis may also cause renal injury that prolongs renal failure. The purpose of this perspective is to understand the results of the recent, largely negative, clinical trials in view of recent advances in the epidemiology of ARF. This review will also discuss diagnostic tools, strategies for improved design of clinical trials, and other therapeutic interventions that will be needed to properly treat acute renal failure in the 21st century.

Acute Kidney Injury↗

PubMed1983

Amoxapine-associated acute renal failure.

Acute renal failure, a brief seizure, and mild rhabdomyolysis developed in a 27-year-old man following overdosage with the tricyclic antidepressant, amoxapine. Renal function returned to normal approximately ten days following drug ingestion. Strikingly, of 111 cases of amoxapine overdosage reported to the manufacturer, acute renal failure has occurred in 12. Of these 12 patients, seizures were documented in seven, and presumptive or definitive evidence of rhabdomyolysis or myoglobinuria was documented in eight. Three possible mechanisms of the renal failure are (1) acute tubular necrosis secondary to nontraumatic rhabdomyolysis; (2) hypotension-induced acute tubular necrosis; and (3) direct nephrotoxic reaction from amoxapine. Rapid hydration with intravenously administered saline is proposed as a means of reducing the substantial incidence of acute renal failure following amoxapine overdosage.

Acute Kidney Injury↗

PubMed2000

Atrial natriuretic factor in oliguric acute renal failure. Anaritide Acute Renal Failure Study Group.

Atrial natriuretic peptide (ANP), an endogenous hormone synthesized by the cardiac atria, has been shown to improve renal function in multiple animal models of acute renal failure. In a recent multicenter clinical trial of 504 patients with acute tubular necrosis (oliguric and nonoliguric), ANP decreased the need for dialysis only in the oliguric patients. In the present study, 222 patients with oliguric acute renal failure were enrolled into a multicenter, randomized, double-blind, placebo-controlled trial designed to assess prospectively the safety and efficacy of ANP compared with placebo. Subjects were randomized to treatment with a 24-hour infusion of ANP (anaritide, 0.2 microgram/kg/min; synthetic form of human ANP) or placebo. Dialysis and mortality status were followed up for 60 days. The primary efficacy end point was dialysis-free survival through day 21. Dialysis-free survival rates were 21% in the ANP group and 15% in the placebo group (P = 0.22). By day 14 of the study, 64% and 77% of the ANP and placebo groups had undergone dialysis, respectively (P = 0.054), and 9 additional patients (7 patients, ANP group; 2 patients, placebo group) needed dialysis but did not receive it. Although a trend was present, there was no statistically significant beneficial effect of ANP in dialysis-free survival or reduction in dialysis in these subjects with oliguric acute renal failure. Mortality rates through day 60 were 60% versus 56% in the ANP and placebo groups, respectively (P = 0.541). One hundred two of 108 (95%) versus 63 of 114 (55%) patients in the ANP and placebo groups had systolic blood pressures less than 90 mm Hg during the study-drug infusion (P < 0.001). The maximal absolute decrease in systolic blood pressure was significantly greater in the anaritide group than placebo group (33.6 versus 23.9 mm Hg; P < 0.001). This well-characterized population with oliguric acute renal failure had an overall high morbidity and mortality.

Adult↗

PubMed1977

Beneficial effect of propranolol in a histologically appropriate model of postischemic acute renal failure.

Acute renal failure caused in the rabbit by clamping one renal pedicle for 1 hour and removing the opposite kidney produced a histologic picture very similar to that observed in "hypotensive" acute renal failure in man. Intravenous infusion of propranolol, a drug which prevents renin release, at 1 mg/kg for 70 minutes beginning at time of pedicle clamping resulted in significantly lower serum creatinine in this model (2.8 +/- 0.2 mg% at 48 hours with propranolol versus 5.2 +/- 0.8 mg% without). Renin stimulation by dehydration or feeding a low-salt diet enhanced the difference between treated and untreated groups (2.6 +/- 0.4 mg% with propranolol versus 6.2 +/- 1.8 mg% without, after dehydration; 3.5 +/- 1.0 mg% with propranolol versus 7.6 +/- 1.4 mg% without, after low-salt diet).Suppression of renin production by saline feeding eliminated propranolol's beneficial effect (5.6 +/- 0.9 mg% with propranolol versus 4.0 +/- 0.6 mg% without). In rabbits with a normal food and water intake, renal denervation using phenol also eliminated propranolol's effect (creatinine 8.6 +/- 1.4 mg% with propranolol versus 8.6 +/- 1.8 mg% without). In rabbits with intact kidneys, flow probe recording of renal blood flow showed a significantly higher blood flow immediately after unclamping in the propranolol-treated animals, and renal angiograms showed less vasoconstriction in this group after unclamping. In this model of acute renal failure, renal vasoconstriction plays an important role following the initial ischemic insult. Propranolol lessens the severity of this vasoconstriction and the resulting acute renal failure. Its probable action is interference with neurogenically stimulated renin release.

Acute Kidney Injury↗

PubMed2000

An evaluation of pharmacological strategies for the prevention and treatment of acute renal failure.

Acute renal failure (ARF) occurs frequently in hospitalised patients, and is associated with significant morbidity and mortality. The most common and generalised forms of acute renal failure are pre-renal conditions and intra-renal acute tubular necrosis (ATN). Pre-renal ARF in its pure state should be entirely reversible by restoring renal perfusion, but in some cases ATN has already occurred. ATN remains a more vexing problem, and is seen most often with hypotension, perioperative or systemic inflammatory stresses, radiocontrast administration, and exposure to nephrotoxins. Among the available pharmacological options for prevention or treatment of ATN, there is a remarkable lack of definitive evidence supporting specific therapy in any setting. Although loop diuretics, mannitol, and dopamine are frequently used for prevention and/or treatment of ATN, clinical studies have failed to prove value. Other drugs with theoretical value, specifically atrial natriuretic peptide analogues, adenosine blockers, and calcium antagonists, have been insufficiently studied to recommend use. Other pharmacological options may arise in the future. Ensuring adequate intravascular fluid volume remains the only approach to managing ATN which can be considered relatively effective and safe. Given the abundant theoretical basis for the prevention and treatment of ATN with drugs, well conducted clinical studies with relevant outcome measures are clearly warranted.

Acute Kidney Injury↗

PubMedDate not supplied

Failure to prostaglandin A1 to modify renal diatrizoate uptake in experimental acute renal failure.

Acute renal failure (ARF) was induced in rats by intramuscular injection of glycerol. Forty-eight hours later prostaglandin A1 (PGA1) in a dose of 1, 5 or 25 microgram/kg bodyweight or phosphate buffer was infused intravenously over 15 min into these animals and controls. After 14 min, 125I-labeled diatrizoate was injected intravenously in a dose of 15 mg/kg bodyweight. Uptake and distribution of diatrizoate were measured one minute later in whole kidneys or kidney slices to provide indices of glomerular filtration. Diatrizoate concentrations were also measured in liver, plasma and washed red cells. Plasma volume was estimated with 125I-labeled albumin. PGA1 produced a dose-related increase in plasma diatrizoate concentration in ARF which was not accounted for by changes in uptake by the kidney, liver or red cells or by changes in plasma volume. It exceeded the relatively small increase in diatrizoate uptake which occurred in the kidney. Intrarenal distribution of diatrizoate did not change. These observations in the kidney suggest that intravenous PGA1 does not improve glomerular filtration in this model of established ARF.

Acute Kidney Injury↗

PubMed1992

Therapeutic implications of arachidonic acid metabolism in transplant-associated acute renal failure.

Acute renal failure is common in kidney transplantation due to immunologic, nephrotoxic, and ischemic events. In this paper the subject of posttransplant acute renal failure is reviewed in relation to arachidonic acid metabolism. Although experimental abnormalities noted in ischemia, rejection, and cyclosporin nephrotoxicity are discussed separately, it is obvious that in the clinical situation there is great overlap. The effects of altering the substrate arachidonic acid by feeding of dietary omega-3 fatty acids, both experimentally and clinically, are discussed. Finally, the limited clinical trials of prostaglandin analogues in renal transplant patients show conflicting conclusions as regards beneficial effects on rejection and renal function. Careful clinical studies of compounds with proven efficacy in animals are needed if acute renal failure posttransplant is to be modified or prevented.

Acute Kidney Injury↗

PubMed2003

[Salmonella infection complicated with acute renal failure].

Acute renal failure is a known complication to Salmonella gastroenteritis, and patients with chronic renal failure or impaired host defence are at increased risk. In the two presented cases there had been a few days of gastroenteritis before the hospitalisation, but the only symptoms at the admission were fatigue and dyspnoea. In both cases severe uraemia had developed and the patients and their physicians did not expect the episode of gastroenteritis to be the only etiology of acute renal failure. Both patients had normal renal histology and Salmonella was grown in their faeces. Subsequently, their renal function was normalised. In these patients dialysis and renal biopsies would have been unnecessary if the ability of even a moderate Salmonella infection to cause acute renal failure in a healthy subject had been realised and prompt rehydration had been initiated.

Acute Kidney Injury↗

PubMed2002

Choice of dialysis modality for management of pediatric acute renal failure.

Acute renal failure in children requiring dialysis can be managed with a variety of modalities, including peritoneal dialysis, intermittent hemodialysis, and continuous hemofiltration or hemodiafiltration. The choice of dialysis modality to be used in managing a specific patient is influenced by several factors, including the goals of dialysis, the unique advantages and disadvantages of each modality, and institutional resources. This review will examine these aspects of acute renal failure management, with the goal of providing practical guidance regarding modality selection to the physician involved in the management of pediatric acute renal failure.

Acute Kidney Injury↗