Ghimire Madhav, Pahari Bishnu, Sharma Sanjib Kumar, Thapa Lekhjung, Das Gayatri, Das G C
Department of Nephrology, College of Medical Sciences Teaching Hospital, Bharatpur, Nepal.
Saudi J Kidney Dis Transpl. 2014 Jul;25(4):912-7. doi: 10.4103/1319-2442.135229.
Acute kidney injury (AKI) is a common and major complication of sepsis. Sepsis-induced AKI is associated with higher morbidity and mortality. A prospective study was designed to include all the patients with a provisional diagnosis of sepsis with AKI admitted in our intensive care unit from August 2009 to September 2010. Detailed demographic data including various clinical parameters, co-morbidities, investigations, complications and outcome were entered in a designated proforman and were analyzed. A total of 53 subjects with the provisional diagnosis of sepsis with AKI were included in the study. The majority of patients (60.37%) were female. The mean age of the study population was 45.84 ± 20.5 years. Forty-nine percent of the subjects were <45 years old and 26.4% patients were >65 years. Among the co-morbid conditions, 9.4% subjects had diabetes mellitus type 2. Among the primary causes of AKI, 72% of the cases were due to medical causes, in which pneumonia was the major cause, and 28% were due to surgical causes, in which cholecystitis was the major cause. 47.1% cases expired, 11.3% subjects left against medical advice and 41.5% cases had favorable outcome. Among the expired cases, 20.7% subjects expired within 24 h; for others, the median hospital stay was four days. This prospective study showed that the major causes of AKI were medical illness and pneumonia. Mortality in sepsis-induced AKI is significantly high. This highlights the importance of prevention of AKI in sepsis by early and renal-friendly aggressive treatment of sepsis and the need for improvement in the management of such AKI cases.
急性肾损伤（AKI）是脓毒症常见且主要的并发症。脓毒症诱导的急性肾损伤与更高的发病率和死亡率相关。一项前瞻性研究纳入了2009年8月至2010年9月期间入住我们重症监护病房、初步诊断为脓毒症合并急性肾损伤的所有患者。将详细的人口统计学数据，包括各种临床参数、合并症、检查、并发症及转归录入指定的表格并进行分析。该研究共纳入53例初步诊断为脓毒症合并急性肾损伤的受试者。大多数患者（60.37%）为女性。研究人群的平均年龄为45.84±20.5岁。49%的受试者年龄<45岁，26.4%的患者年龄>65岁。在合并症中，9.4%的受试者患有2型糖尿病。在急性肾损伤的主要病因中，72%的病例是由内科原因引起，其中肺炎是主要病因；28%是由外科原因引起，其中胆囊炎是主要病因。47.1%的病例死亡，11.3%的受试者自动出院，41.5%的病例转归良好。在死亡病例中，20.7%的受试者在24小时内死亡；其他患者的中位住院时间为4天。这项前瞻性研究表明，急性肾损伤的主要病因是内科疾病和肺炎。脓毒症诱导的急性肾损伤死亡率显著较高。这凸显了通过早期且肾脏友好的积极治疗脓毒症来预防急性肾损伤的重要性，以及改善此类急性肾损伤病例管理的必要性。
