Carvalho M F, Barretti P, Inuzuka L M, Sueto M, Nishimura M R, Caramori J C, Balbi A L, Corrêa L A, Soares V A
Department of Internal Medicine, Botucatu Medical School, São Paulo, Brazil.
Ren Fail. 1997 Mar;19(2):259-65. doi: 10.3109/08860229709026286.
In order to evaluate the role of underlying disease in the high mortality observed in acute renal failure (ARF) and risk factors related to the development of oliguric ARF in renal allograft recipients, two groups were selected: 34 patients with native kidneys, aged 16 and 57 years, and presenting ischemic ARF caused by cardiovascular collapse, with no signs of infection at the time of diagnosis; and 34 renal allograft recipients who developed ARF immediately after transplantation, without rejection. ARF was defined either as 30% increase of basal plasmatic creatinine in patients with native kidneys or nonnormalization of plasmatic creatinine at day 5 after transplantation in renal allograft recipients; oliguria as diuresis < or = 400 mL/24 h. There were no differences in age, male frequency, oliguria presence and duration, need for dialysis, and infection episodes for renal allograft recipients and patients with native kidneys. The development of sepsis (3% and 41%) and death rate (3% and 44%) were higher in patients with native kidneys (p < 0.01). The renal allograft recipients with both oliguric (n = 18) and nonoliguric (n = 16) ARF were evaluated and no difference was observed in the recipient's age, donor's age, cold ischemia time, time elapsed until plasmatic creatinine normalization, donor's plasmatic creatinine or urea, and mean arterial pressure. No differences were observed between the groups regarding frequency of infection episodes during ARF and frequency of death. In conclusion, renal allograft recipients presented a lower death rate and were less susceptible to sepsis. Cold ischemia time, age, and hemodynamic characteristics of the donor did not affect the development of oliguria.
为了评估基础疾病在急性肾衰竭（ARF）高死亡率中的作用以及肾移植受者少尿型ARF发生发展的相关危险因素，选取了两组患者：34例年龄在16至57岁之间的有自身肾脏的患者，因心血管衰竭导致缺血性ARF，诊断时无感染迹象；34例肾移植受者，移植后立即发生ARF，无排斥反应。ARF的定义为：有自身肾脏的患者基础血浆肌酐升高30%，或肾移植受者移植后第5天血浆肌酐未恢复正常；少尿定义为尿量<或=400 mL/24 h。肾移植受者和有自身肾脏的患者在年龄、男性比例、少尿的存在和持续时间、透析需求以及感染发作方面无差异。有自身肾脏的患者败血症发生率（3%和41%）和死亡率（3%和44%）更高（p<0.01）。对少尿型（n = 18）和非少尿型（n = 16）ARF的肾移植受者进行评估，在受者年龄、供者年龄、冷缺血时间、血浆肌酐恢复正常所需时间、供者血浆肌酐或尿素以及平均动脉压方面未观察到差异。两组在ARF期间的感染发作频率和死亡频率方面也未观察到差异。总之，肾移植受者死亡率较低，对败血症的易感性较低。冷缺血时间、年龄和供者的血流动力学特征不影响少尿的发生。
