Dimitrakov D, Despotov T, Kumtchev E, Tzekov V, Tilkian E, Manev E, Stavrev P, Velitchkova E, Pandeva S, Nikolov D
Department of Nephrology, Higher Medical Institute, Plovdiv, Bulgaria.
Folia Med (Plovdiv). 1997;39(4):93-7.
In the present study we highlight the epidemiology, etiologic spectrum, and evaluation of ARF in adults. We then expand on the pathophysiologic mechanisms of renal failure and discuss the rationale for current therapeutic strategies in ARF patients. A total of 79 patients (45 male, female 34), aged 18-75 years (median age 51.2 +/- 17.7 years) with acute renal failure were studied in 5 years (January 1990 through October 1995). Emergency hemodialysis sessions following an acute anuric episode were instituted in 39 cases (49.3% of all patients). The median number of hemodialysis procedures per patient treated at our institution was 3.2 +/- 1.9. The total number of acute interstitial nephritis-associated ARF was 40. In 30 of them (75%) the acute renal insult included a combination of several therapeutic antimicrobial agents, in 2 cases (5%) ARF followed the administration of nonsteroidal anti-inflammatory drugs, in 1 (2.5%) it resulted from a combined therapeutic regimen and in the remaining 5 (12.5%) from the application of a single drug. Acute interstitial nephritis developed in 2 patients following a viral infection. In the hemodialysis-treated ARF group 12 patients (29.77%) had interstitial nephritis and 2 patients (5.13%) presented with renal impairment for an unspecified period of time preceding the development of overt ARF. In a subset of this group of patients, ARF occurred in 7 patients (17.95%) following an urologic intervention, in 8 patients (20.51%) as a consequence of thermal or mechanical trauma or intoxication and in 3 cases (7.69%) it resulted from fever of unknown origin. Three patients with postoperative peritonitis and 4 other (10.26%) with postoperative complications were encountered in our series. No cases of septic abortion-related or obstetric-related ARF were recorded. 92.3% of all hemodialysis-treated patients seen at our Institution had received a combination of antibiotics and only 2 patients had been pre-treated with a single antimicrobial agent. Our results underscore the strong tendency towards diversity in the etiologic spectrum of clinical entities causing ARF and the increase in the number of acute interstitial nephritis. These factors highlight the importance of precise dosing and administration of drugs, especially antibiotics, as well as the duration of antibiotic treatment.
在本研究中，我们着重介绍了成人急性肾衰竭（ARF）的流行病学、病因谱及评估。接着阐述了肾衰竭的病理生理机制，并讨论了当前ARF患者治疗策略的理论依据。在5年时间里（1990年1月至1995年10月），共研究了79例年龄在18至75岁（中位年龄51.2±17.7岁）的急性肾衰竭患者。39例患者（占所有患者的49.3%）在急性无尿发作后进行了紧急血液透析治疗。在我们机构接受治疗的患者中，每位患者血液透析治疗的中位次数为3.2±1.9次。与急性间质性肾炎相关的ARF患者共有40例。其中30例（75%）急性肾损伤是由多种治疗性抗菌药物联合使用引起的，2例（5%）ARF是在使用非甾体抗炎药后发生的，1例（2.5%）是由联合治疗方案导致的，其余5例（12.5%）是由单一药物应用引起的。2例患者在病毒感染后发生了急性间质性肾炎。在接受血液透析治疗的ARF组中，12例患者（29.77%）患有间质性肾炎，2例患者（5.13%）在明显的ARF发生前一段时间出现了不明原因的肾功能损害。在这组患者的一个亚组中，7例患者（17.95%）在泌尿外科手术后发生了ARF，8例患者（20.51%）因热或机械性创伤或中毒导致ARF，3例患者（7.69%）因不明原因发热引发ARF。我们的系列研究中遇到了3例术后腹膜炎患者和另外4例（10.26%）有术后并发症的患者。未记录到与感染性流产相关或产科相关的ARF病例。在我们机构接受血液透析治疗的所有患者中，92.3%的患者接受了抗生素联合治疗，只有2例患者预先使用了单一抗菌药物。我们的结果强调了导致ARF的临床病因谱具有明显的多样性倾向以及急性间质性肾炎病例数增加。这些因素突出了精确给药和用药，尤其是抗生素，以及抗生素治疗持续时间的重要性。
