The spectrum of acute renal failure in a developing country - abstract

ABSTRACT

Acute renal failure (ARF) has had an unchanged mortality of greater than 50 percent for the past 30 years, despite advances in critical care management. The aetiologies, complications, and prognosis have been well described in the literature from developed countries. A 30-month prospective survey of all cases of ARF seen at the Princess Margaret Hospital since January 1986 was undertaken. Of a total of 1,014 cases, 98 were analyzed; and the principal findings were the following. Sepsis was the leading cause identified in 47 patients (48 percent); Hypoperfusion-related states occurred in 41 patients (42 percent); Nephrotoxins were identified in 18 patients (18 percent); Vasculatic disease accounted for 15 patients, and Obstructive uropathy was the major factor in 11 patients. Nearly 50 percent of the patients had non-oliguric ARF. The mortality was 36.1 percent, and 67.3 percent in the non-oliguric and oliguric groups, respectively. Seven patients were classified as having died due to renal failure, and the overall combined mortality of all the patients was 51 percent. Of the 98 patients, 21 had complete recovery (21 percent); 23 patients had renal insufficiency (24 percent); and 47 patients (48 percent) were classified as non-renal deaths. A new entity of Cocaine-induced Rhabdomyolysis is described in 2 patients and the pathogenesis discussed. This survey indicates that the mortality of 55 percent in this developing country is comparable to figures reported from more advanced metropolitan countries (AU)