| Abstract|| |
Fifty consecutive patients of acute renal failure (ARF) seen over a period of two years at the Dammam Central Hospital, Dammam were studied. The mean age of the patients was 39.3 years ranging from 14 to 90 years. The main etiological factors for ARF were acute tubular necrosis (67.5%) and obstructive uropathy (30%). The mortality rate was 26% and the poor prognostic factors included sepsis, acidosis, shock and the need for emergency hemodialysis.
Keywords: Acute renal failure, Dammam, Saudi Arabia, Mortality.
|How to cite this article:|
Ghacha R, Sinha AK, Al-Khursani IA. Clinical Spectrum of Acute Renal Failure in Dammam Central Hospital, Dammam, Saudi Arabia. Saudi J Kidney Dis Transpl 2000;11:605-9
|How to cite this URL:|
Ghacha R, Sinha AK, Al-Khursani IA. Clinical Spectrum of Acute Renal Failure in Dammam Central Hospital, Dammam, Saudi Arabia. Saudi J Kidney Dis Transpl [serial online] 2000 [cited 2019 Nov 19];11:605-9. Available from: http://www.sjkdt.org/text.asp?2000/11/4/605/36649
| Introduction|| |
Acute renal failure (ARF) is characterized by the deterioration of renal functions over a period of hours to weeks, causing failure of the kidneys to excrete nitrogenous waste products as well as to maintain fluid and electrolyte homeostasis.  In spite of the progress achieved in the understanding of all aspects of ARF, its morbidity and mortality still remains high. ,
There are different causes that can lead to the development of ARF. ,,, They include decreased renal perfusion without cellular injury, ischemic, toxic or obstructive insult to the renal tubules, a primary reduction in the filtering capacity of the glomerulus, tubulointerstitial inflammation or, obstruction to the urine outflow tract. Although the morbidity and mortality are still high, yet the prognosis of ARF depends on certain aspects. These include the availability of appropriate medical facilities, socioeconomic status of the patient as well as awareness of the disease. 
The extreme climatic conditions and multi-national population in Saudi Arabia seem to play a major role in affecting the etiology of ARF. Thus, rhabdomyolysis of varied etiologies, obstructive uropathy due to renal stone disease, and bilharziasis commonly cause ARF in this region. ,,
This study was conducted to assess the common etiological factors that result in ARF and the risk factors that are responsible for the high mortality.
| Material and Methods|| |
All patients admitted with a diagnosis of ARF, as well as those who developed ARF during their stay in the Dammam Central Hospital, Dammam were studied over a period of two years. Data regarding their clinical characteristics, etiological spectrum, severity of the disease and final outcome were analyzed. Patients with pre-renal failure or pre-existing chronic renal failure were excluded.
The study was conducted by recording the essential data of each patient. The management of ARF was in the form of conservative treatment or dialysis, which was used as and when necessary. The patients were followed-up until return of their renal function to normal, death, or discharge from hospital.
The results were analyzed after collecting the data.
| Results|| |
A total of 50 patients were diagnosed to have ARF during the two-year study period. There were 36 (72%) Saudis and 14 (28%) non-Saudis [Table - 1].
The mean age of the patients was 39.3 years ranging from 14 to 90 years. Twentyeight patients (46%) were between 14 to 60 years, 12 (24%) between 61 to 70 years and 10 (20%) above 70 years [Figure - 1]. There were 43 (86%) males and seven (14%) females.
The main clinical presentations included oliguria in 26 patients (52%), anuria in 16 (32%) and miscellaneous in eight patients (16%) [Table - 2]. The major etiological factors for ARF were acute tubular necrosis (ATN) in 35 (70%) and obstructive uropathy in 13 (26%) while there were one patient (2%) each with acute interstitial nephritis and glomerulonephritis secondary to Henoch-Schonlein purpura.
The causes of ATN included sepsis in 10 (28.6%), hypotension in six (17.1%) and miscellaneous in 19 patients (54.3%) [Figure - 2]. The causes of obstruction were prostatic enlargement in eight (62%) and renal stone disease in five patients (38%). Twenty-four patients (48%) needed hemodialysis while the remaining were managed conservatively. The time taken for complete recovery varied. Thus, ten patients (27%) recovered in seven days, 16 patients (43.2%) within four weeks while 11 patients (29.7%) took about six weeks to recover.
Study of the final outcome of the ARF patients revealed that 13 patients (26%) died, of whom, four patients (30.7%) received dialysis therapy and nine patients (69.2%) were managed conservatively.
The factors that suggested poor outcome included sepsis, presence of shock or acidosis and the need for hemodialysis at presentation [Table - 3].
| Discussion|| |
Acute renal failure still remains a common problem affecting 5% of all general hospital patients.  The overall mortality may be as high as 50%. This study shows that ARF is a major therapeutic problem at what is perhaps, the busiest hospital in the Eastern Province of Saudi Arabia, namely the Dammam Central Hospital, Dammam.
The mean age and age-distribution of our patients were quite similar to that reported by others.  The frequency of ARF in males was much more than in females, which is different from what is reported in other studies. ,, This may be due to less environmental effect on females as they usually stay indoors.
Study of the etiological pattern revealed that ATN is the commonest cause (70%) followed by obstructive uropathy. This is different from another study from the region which showed the incidence of obstructive uropathy to be as high as 35%, especially in males.  Rhabdomyolysis and aminoglycoside nephrotoxicity were important etiological factors causing ARF despite the preventive measures taken in the form of forced alkaline diuresis and monitoring of serum drug levels respectively. In this study, three cases of rhabdomyolysis (6%) and two cases of aminoglycoside nephrotoxicity (4%) were noted. This prevalence rate is comparable to the earlier reported cases. ,,,
The prevalence of other etiologies of ARF such as malignant hypertension, vasculitis, hepatorenal syndrome, contrast related nephropathy and interstitial nephritis were similar to earlier reports. ,,, One patient had ARF due to acute interstitial nephritis based on renal biopsy, but the etiology of the same could not be ascertained. This patient needed three sessions of hemodialysis before recovery was noted. Corticosteroids were not prescribed in this patient.
Thirty-seven (74%) out of the 50 study patients recovered from renal failure. Thirteen patients (26%) died during the treatment. Six of the 37 patients who recovered from renal failure, died due to their basic disease which was responsible for renal failure. Sepsis in combination with shock and acidosis was the commonest cause of death (30.8%) followed by cardiac events (23.1%).
Surprisingly, we did not encounter even a single case of ARF due to obstetrical cause, which probably reflects improved obstetrical practice prevailing in this region. 
Our study further suggests that in spite of advances made in the field, sepsis associated with shock and acidosis constitutes not only the major etiological factor for ARF, but also remains the leading cause of mortality in these patients. We stress the need for better management of sepsis at the earliest possible stage, before it results in renal failure.
| Acknowledgement|| |
We heartily thank Mr. Mohiuddin, typist, who helped in completion of this article.
| References|| |
|1.||Thadhani R, Pascual M, Bonventre JV. Acute renal failure. N Engl J Med 1996;334:1448-60. [PUBMED] [FULLTEXT]|
|2.||Novis BK, Roizen MF, Aronson S, Thisted RA. Association of preoperative risk factors with postoperative acute renal failure. Anesth Analg 1994;78:143-9. [PUBMED] |
|3.||Zanardo G, Michielon P, Paccagnella A, et al. Acute renal failure in the patient undergoing cardiac operation: prevalence, mortality rate, and main risk factors. J Thorac Cardiovasc Surg 1994;107:1489-95. [PUBMED] |
|4.||Kuska J, Kokot F, Marcinkowski W, et al. Analysis of patients with acute renal disease treated in the dialysis centers of the Silesian region in the year 1965-1985. Mater Med Pol 1988;20:185-9. [PUBMED] |
|5.||Lien J, Chan V. Risk Factors influencing survival in acute renal failure treated by hemodialysis. Arch Intern Med 1985; 145:2067-9. [PUBMED] |
|6.||Werb R, Linton AL. Aetiology, diagnosis, treatment and prognosis of acute renal failure in an intensive care unit. Resuscitation 1979;7:95-100. [PUBMED] [FULLTEXT]|
|7.||Wilkins RG, Faragher EB. Acute renal failure in an intensive care unit: incidence, prediction and outcome. Anaesthesia 1983;38:628-34. [PUBMED] |
|8.||Mitwalli AH, Al-Swailem AR, Paul TT, et al. Acute renal failure in Al-Madina region, Saudi Arabia. Saudi Kidney Dis Transplant Bull 1992;3:95-100. |
|9.||Rose GA. Urinary stones: clinical and laboratory aspects, hot climate or chronic dehydration store disease. Lancaster, MTP Press Ltd., 1982:233-5. |
|10.||Hutt MS. The geography of renal disease in Siv Black D, Jones MF (eds); Renal Disease 4th Ed. Oxford. Blackwell Scientific Publications 1979:869-78. |
|11.||AlKhunaizi AM, Schrier RW. Management of acute renal failure: new perspectives. Am J Kidney Dis 1996;28:315-28. [PUBMED] |
|12.||Anderson RJ, Linas SL, Berns AS, et al. Nonoliguric acute renal failure. N Engl J Med 1977;296:1134-5. [PUBMED] |
|13.||Elhadi TA, Abdelrahman OM, Abdelgadir EI. Pattern of acute renal failure in general hospital in Saudi Arabia. Saudi Kidney Dis Transplant Bull 1990;1(2):89-93. |
|14.||Al-Swailem AR, Mitwalli AH, Paul TT, Aziz KM, Aswad S. Profile of acute renal failure in Gizan Region, Kingdom of Saudi Arabia. Saudi Kidney Dis Transplant Bull 1991;2(2):67-73. |
|15.||Hadidy S, Asfari R, Shammaa MZ, Hanifi MI. Acute renal failure among a Syrian population, incidence, aetiology treatment and outcome. Int Urol Nephrol 1989;21: 455-61. [PUBMED] |
|16.||Said R, Hussain M, Veverbrandts E. Acute renal failure in Saudi Arabia: analysis of 100 cases. Kidney Int 1985;27:152. |
|17.||Hou SH, Bushinsky DA, Wish JB, Cohen JJ, Harrington JT. Hospital-acquired renal insufficiency: a prospective study. Am J Med 1983;74:243-8. [PUBMED] |
|18.||Byrd L, Sherman RL. Radiocontrast-induced acute renal failure: a clinical and pathophysiological review. Medicine 1979;58:270-9. [PUBMED] |
|19.||Kibukamusoke JW, Chugh KS, Sakhiya V. Renal effects of evenomation in: Kibukamusoke JW (ed): Tropical Nephrology Canberr City, Citforge Pty Ltd, 1984;171-98. |
Department of Nephrology, Dammam Central Hospital, P.O. Box 8061, Dammam 31482
[Figure - 1], [Figure - 2]
[Table - 1], [Table - 2], [Table - 3]