[Severe sepsis as a cause of acute renal failure]. / Sepsis severa como causa de falla renal aguda.

INTRODUCTION: The most common causes of acute renal failure in the intensive care units are severe sepsis and septic shock. Mortality reported in this kind of patients is about 70%. The pathophysiology of acute renal failure in severe sepsis includes systemic hypotension, direct renal vasoconstriction, infiltration of the kidney by inflammatory cells, renal ischemia, intraglomerular thrombosis and intratubular obstruction. OBJECTIVE: To show the incidence, mortality and histopathological etiology of acute renal failure in severe sepsis. TYPE STUDY: Retrospective, transversal and descriptive. METHODS: We study 332 cases of patients with severe sepsis, who were hospitalized in the Intensive Care Unit of Hospital General del Centro Médico Nacional, during five years. From these patients 107 developed acute renal failure due to severe sepsis. This group recived two differet kind of treatment, medical management (70%) and hemodyalisis (30%). Renal biopsy was taken in 40 patients after six or seven days of the diagnosis of acute renal failure caused by severe sepsis. RESULTS: In the group of 332 patients with severe sepsis 107 developed acute renal failure, this represents the 32.22%. The group of patients with renal biopsy presented the following results: 50% had acute tubular necrosis, 27.5% presented glomerular and tubular lesion, the rest 22.5% had glomerular and vascular lesion. The mortality for patients treated with medical management was of 69.3%, and for those treated with hemodyalisis was of 28.1%. DISCUSSION: Nowadays, and due to the high incidence and mortality of this disease, is very important to generate more concise knowledge about the genesis and development of acute renal failure in the septic patient.

Sepsis severa como causa de falla renal aguda / Severe sepsis as a cause of acute renal failure

Introducción: Las causas más comunes de insuficiencia renal aguda en las unidadesde cuidados intensivos son la sepsis severa y el choque séptico. La mortalidadreportada en los pacientes con sepsis severa e IRA es hasta del 70%. Lafisiopatología propuesta para la falla renal en la sepsis grave incluye una combinaciónde factores como hipotensión sistémica, vasoconstricción renal, infiltraciónde células inflamatorias en el riñón, trombosis intraglomerular y obstrucción intratubular.Objetivos: Mostrar la incidencia, mortalidad y la histología de la insuficienciarenal aguda causada por sepsis severa.Diseño del estudio: Retrospectivo, descriptivo y transversal.Metodología: Se estudiaron retrospectivamente los casos de 332 pacientes conel diagnóstico de sepsis severa que fueron hospitalizados en la Unidad de CuidadosIntensivos del Hospital General del Centro Médico Nacional en el lapso deun lustro. De este total de pacientes 107 presentaron insuficiencia renal aguda secundariaa dicho proceso séptico. El diagnóstico se efectuó con base en las alteracionesde las pruebas funcionales renales (DCr, DmOms, DH20, U/PmOsm,FENA, FEK y IFR). Los pacientes fueron tratados de dos modos distintos, mediantemanejo médico (70%) o con hemodiálisis (30%). A 40 de ellos se les tomóbiopsia renal percutánea entre los seis y siete días posteriores a su diagnóstico.Todas las biopsias fueron estudiadas por microscopia óptica.Resultados: Del grupo de 332 pacientes con sepsis severa 107 presentó insuficienciarenal aguda, lo que representa el 32,22% de la población en este grupo40 pacientes (100%) a los que se les tomó biopsia renal; 20 pacientes (50%) tuvieronnecrosis tubulointersticial, 11 pacientes (27,5%) desarrollaron lesión glomerulary tubular, y el resto 9 pacientes (22,5%) presentaron lesión glomerular yvascular.La mortalidad para el grupo tratado con manejo médico fue del 69,3%, mientrasque la del grupo tratado con hemodiálisis fue del 28,1%.Discusión: Es necesario generar conocimientos más exactos sobre la génesis ydesarrollo de la IRA en el paciente séptico, ya que la mortalidad en estos pacientescontinua siendo elevada a pesar del inicio de diálisis temprana en cualquierade sus modalidades, aun con las de reemplazo renal continuo

Introduction: The most common causes of acute renal failure in the intensivecare units are severe sepsis and septic shock. Mortality reported in this kind ofpatients is about 70%. The pathophysiology of acute renal failure in severe sepsisincludes systemic hypotension, direct renal vasoconstriction, infiltration of thekidney by inflammatory cells, renal ischemia, intraglomerular thrombosis and intratubularobstruction.Objective: To show the incidence, mortality and histopathological etiology ofacute renal failure in severe sepsis.Type study: Retrospective, transversal and descriptive.Methods: We study 332 cases of patients with severe sepsis, who were hospitalizedin the Intensive Care Unit of Hospital General del Centro Médico Nacional,during five years.From these patients 107 developed acute renal failure due to severe sepsis. Thisgroup recived two differet kind of treatment, medical management (70%) and hemodyalisis(30%).Renal biopsy was taken in 40 patients after six or seven days of the diagnosisof acute renal failure caused by severe sepsis.Results: In the group of 332 patients with severe sepsis 107 developed acuterenal failure, this represents the 32.22%. The group of patients with renal biopsypresented the following results: 50% had acute tubular necrosis, 27.5% presentedglomerular and tubular lesion, the rest 22.5% had glomerular and vascular lesion.The mortality for patients treated with medical management was of 69.3%, andfor those treated with hemodyalisis was of 28.1%.Discussion: Nowadays, and due to the high incidence and mortality of this disease,is very important to generate more concise knowledge about the genesisand development of acute renal failure in the septic patient