Liaño F, Junco E, Pascual J, Madero R, Verde E
Kidney Int Suppl. 1998 May;66:S16-24.
Acute renal failure (ARF) is at a crossroads between nephrology and intensive care medicine. However, there seems to be wide differences between the ARF observed in the intensive care unit (ICU) compared to that observed in other areas of the hospital, particularly when examining the mortality rate. Among the ICU patients the 70% mortality rate is higher to the 50% found in an overall series of studies. Recently, Druml proposed that there is a changing trend in the clinical spectrum of ARF as a convincing reason to justify these differences. According to him, we are moving from an ARF seen as a mono-organ failure to another one observed in a multiorgan dysfunction syndrome (MODS) context. Although extremely coherent, this hypothesis has not been fully confirmed in a prospective study. In fact, most authors seem to look at the problem from opposite sides of the river, either from the critical medicine or the nephrological bank. To the best of our knowledge, only one retrospective study has dealt with this topic by comparing outcome of ARF in ICU and non-ICU patients. In this article we aim to overcome this problem by reviewing the data of the prospective epidemiological ARF study carried out in Madrid using two different approaches: (1) comparing the ARF cases observed in the ICU setting with those ARF studied outside the ICU, and (2) comparing the outcome of isolated ARF with the outcome of ARF as part of a MODS in patients treated in both settings.
急性肾衰竭（ARF）处于肾脏病学和重症医学的交叉点。然而，在重症监护病房（ICU）观察到的ARF与在医院其他区域观察到的ARF之间似乎存在很大差异，尤其是在检查死亡率时。在ICU患者中，70%的死亡率高于在一系列整体研究中发现的50%。最近，德鲁姆提出ARF的临床谱存在变化趋势，以此作为解释这些差异的令人信服的理由。据他所说，我们正从被视为单器官衰竭的ARF转向在多器官功能障碍综合征（MODS）背景下观察到的另一种ARF。尽管这一假设极具连贯性，但尚未在前瞻性研究中得到充分证实。事实上，大多数作者似乎是从河的两岸来看待这个问题，要么从重症医学的角度，要么从肾脏病学的角度。据我们所知，只有一项回顾性研究通过比较ICU和非ICU患者中ARF的结局来处理这个主题。在本文中，我们旨在通过回顾在马德里进行的前瞻性流行病学ARF研究的数据，采用两种不同的方法来克服这个问题：（1）将在ICU环境中观察到的ARF病例与在ICU之外研究的ARF病例进行比较，（2）比较在两种环境中治疗的患者中孤立性ARF的结局与作为MODS一部分的ARF的结局。
