Barretti P, Soares V A
Departmento de Clínica Médica, Faculdade de Medicina-UNESP, Botucatu, SP.
Rev Assoc Med Bras (1992). 1996 Apr-Jun;42(2):67-72.
Acute renal failure (ARF) is a frequent complication in hospitalized patients, and is strongly related to increase of mortality.
To analyze the clinical outcome and the prognostic factors in hospital acquired AFR.
A prospective study was performed. Data from 200 patients with established ARF admitted during the period of January, 1987 and July, 1990 were collected.
The incidence of ARF was 4.9/1000 admissions. Renal ischemia (50%) and nephrotoxic drugs (21%) were the main etiologic factors. The histologic study done in 43 patients showed: acute tubular necrosis (53%), tubular hydrophic degeneration (16%), glomerulopathies (16%) and other lesions (15%). Dialysis therapy was performed in 101 patients and the main indications were: uremia (67%), hypervolemia (22%) and hyperkalemia (9%). The mortality rate was 46.5% and the most important causes of death were: sepsis (38%), respiratory failure (19%) and multiple organs failure (11%). Treatment withdraw was the cause of death in 2 patients. Higher mortality was observed in oliguric patients (62.9%) than non-oliguric (34.5%) (p < 0.05) and in ischemic renal failure (56.7%) when compared to nephrotoxic renal failure (14.7%) (p < 0.05). This difference was maintained when the comparison was done only between dialyzed patients.
As primary cause of death was not associated to the acute renal failure, we conclude that acute renal failure is an important marker of the gravity of the underlying disease and not the cause of death.
急性肾衰竭（ARF）是住院患者常见的并发症，与死亡率升高密切相关。
分析医院获得性急性肾衰竭的临床结局及预后因素。
进行一项前瞻性研究。收集了1987年1月至1990年7月期间收治的200例确诊急性肾衰竭患者的数据。
急性肾衰竭的发生率为4.9/1000例入院患者。肾缺血（50%）和肾毒性药物（21%）是主要病因。对43例患者进行的组织学研究显示：急性肾小管坏死（53%）、肾小管水样变性（16%）、肾小球病变（16%）和其他病变（15%）。101例患者接受了透析治疗，主要指征为：尿毒症（67%）、血容量过多（22%）和高钾血症（9%）。死亡率为46.5%，主要死亡原因是：败血症（38%）、呼吸衰竭（19%）和多器官功能衰竭（11%）。2例患者因放弃治疗死亡。少尿患者的死亡率（62.9%）高于非少尿患者（34.5%）（p<0.05），缺血性肾衰竭患者的死亡率（56.7%）高于肾毒性肾衰竭患者（14.7%）（p<0.05）。仅在接受透析的患者之间进行比较时，这种差异依然存在。
由于主要死亡原因与急性肾衰竭无关，我们得出结论，急性肾衰竭是基础疾病严重程度的重要标志，而非死亡原因。
