| Abstract|| |
We evaluated retrospectively the etiology and outcome of acute renal failure (ARF) in 84 patients in Rasheed Renal Center in Baghdad, Iraq from June 1998 through March 1999. They were 82 males and 2 females with ages that ranged between 5 and 80 years. Prerenal ARF was the commonest type found in 45 (53.6%) patients followed by renal ARF in 33 (39.3%) patients and acute obstructive uropathy in six (7.1%) patients. Clinically, 74 patients presented with oligo-anuria, while 10 patients presented with nonoliguria. Of the oligo-anuric group, 61 (82.4%) patients required renal replacement therapy (RRT) and 50 (67.6%) patients had complete recovery. The mortality rate was 25.67% in the oliguric group, while none in the non-oliguric group required RRT and the complete recovery rate was 100%. The overall survival in both groups was (77.4%). The patterns of ARF in our center were mostly compatible with the previous reports from the region.
Keywords: Renal failure, Acute, Oliguria, Iraq.
|How to cite this article:|
Al-Taee IK, Al-Shamma IA, Jabber FA. Acute Renal Failure in a Renal Center, Iraq. Saudi J Kidney Dis Transpl 2004;15:71-4
|How to cite this URL:|
Al-Taee IK, Al-Shamma IA, Jabber FA. Acute Renal Failure in a Renal Center, Iraq. Saudi J Kidney Dis Transpl [serial online] 2004 [cited 2019 Sep 20];15:71-4. Available from: http://www.sjkdt.org/text.asp?2004/15/1/71/32972
| Introduction|| |
Acute renal failure (ARF) is a medical emergency characterized by an abrupt decline in renal function that results in retention of nitrogenous wastes irrespective of urine out put causing rapid rise in blood urea and serum creatinine. ARF may manifest as anuria, oliguria or non-oliguria. , It is customary to classify ARF in to three major groups, prerenal, renal, and postrenal. ,
The incidence of ARF in general hospital admissions is 5 % worldwide. The European dialysis and transplantation association (EDTA) survey of 32 countries shows a mean of 28.9 patients per million population per year with ARF that requires dialysis. , For every patient who requires dialysis, there are 10-12 patients with milder renal insufficiency who are managed conservatively without dialysis. The incidence of severe acute renal failure in the community is at least twice as high as the incidence reported from the renal unit based studies as shown by a prospective study of the incidence of severe ARF in adults in two health districts in England. The incidence was estimated to be 140 per million of the total population yearly and 172 per million of the adult population. 
In this study, we attempt to evaluate retrospectively cases of ARF regarding etiology and outcome in a renal center in Iraq.
| Materials and Methods|| |
We evaluated the etiology and the clinical outcome of 84 patients with no previous history of renal impairment and developed ARF during the period from June 1998 through March 1999.
There were 82 males and two females with ages ranged between 5 and 80 years. All patients had complete history and physical examination, and laboratory investigations that included urinalysis, blood urea, serum creatinine, serum electrolytes, urine creatinine, urine sodium, urine specific gravity and urine osmolality. Ultrasonography of the kidneys and bladder were performed on all patients, while CT-scan of the kidneys was performed if indicated. The fractional excretion of sodium (FE Na ) was calculated to Differentiate between prerenal and renal ARF. 
All cases of post-burn ARF were not included in this study, in addition to the cases of acute obstructive uropathy, which were treated conservatively without dialysis.
| Results|| |
Sixty patients (71.4%) were admitted primarily with ARF while 24 patients (28.6%) acquired ARF during their hospitalization for other causes. Oliguria was found in 45 patients and 29 patients had anuria, while non-oliguric ARF was found only in ten patients.
[Table - 1] shows that forty-five (53.6%) patients had prerenal ARF, while 33 (39.3%) patients had renal ARF and the remaining six patients (7.1%) had post-renal ARF. In the prerenal ARF group, infection and GI-loss was the etiology in 34 (75.6%) patients, while renal hypoperfusion and volume depletion due to hemorrhage were found in six (13.3%), heat stroke in three (6.7%), congestive heart failure (CHF) in one (2.2%) and hepatorenal syndrome (HRS) in one (2.2%). In the renal ARF group, acute tubular necrosis (ATN) was the cause in 16 (48.5%) patients; ATN was due to sepsis in 10 (62%) cases, glucose-6-phosphodehydrogenase (G6PD) deficiency in three (18.8%), Rhabdomyolysis in two (12.5%) and tumor lysis in one (6.2%). The second most common finding in the renal ARF group was acute glomerulonephritis (AGN) that accounted for 14 (42.4%) cases. Hemolytic uremic syndrome was responsible for two (6.2%) cases of renal ARF, while acute cortical necrosis (ACN) in one (3%). In the post renal ARF group, renal stone was the commonest cause of urinary obstruction and found in four (66.6%) patients, while ureteric obstruction due to retroperitoneal fibrosis was seen in one (16.7%) and long standing urethral stricture in one (16.7%).
[Table - 2] shows the clinical outcome of ARF in our study patients. Of the oligo-anuric group, 61 (82.4%) patients required renal replacement therapy (RRT) and 50 (67.6%) patients had complete recovery. The mortality rate was 25.67% in the oliguric group, while none in the non-oliguric group required RRT and the complete recovery rate was 100%. The overall survival in both groups was 77.4%.
| Discussion|| |
In this study, prerenal ARF was seen in the majority of patients, while renal ARF ranked second and post-renal ARF ranked third. Infection and GI-loss, hemorrhage and heat stroke were the most common causes of prerenal ARF. All above mentioned conditions lead usually to decreased effective volume and hypovolemia resulting in impaired renal autoregulation of the renal blood flow with afferent arteriolar vasoconstriction leading to fall in GFR. 
In the renal ARF group of patients, acute tubular necrosis due to sepsis was the commonest cause of ARF, which is comparable to results elsewhere. Pathophysiologically, prerenal azotemia due to sepsis can convert easily and rapidly to ATN due to shared pathogenic mechanisms.
In postrenal ARF, all cases of acute obstructive uropathy that needed no RRT were excluded from the study because they were treated in the urology department. This may explain the low incidence of this group in the etiological spectrum of ARF in this study. Renal stones were the most common cause of acute post-renal ARF.
Our results are comparable to Sudanian study, where prerenal was the commonest type of ARF in Sudan followed by post renal and renal ARF.  However, it differs from the multicenter European study by EDTA in 1996, where renal ARF was the most common followed by prerenal and post renal ARF. , The Jordanian study showed renal ARF to be the most common type of ARF and prerenal ARF to be the least common.  Our explanation for this difference is based probably on the fact that causes of ARF in different countries are usually determined by geographical, environmental, and socioeconomic conditions.  Moreover, there may be a possible delay in the referral of the ARF patients to the nephrologist.
The mortality rate of 22.6% in both oliguric and non-oliguric groups is comparable to that reported in a study from Qatar (21.8%),  and the study from Jordan (19.5%).  Our mortality rate also coincides with that mentioned by Chertow. 
| Conclusions|| |
1) Oligouria at presentation of ARF carries a high mortality and morbidity while non-oliguria carries no mortality in our series.
2) Prerenal ARF is the most common causative group of ARF in our patients followed by renal and post-renal ARF.
3) Early referral of critically ill ARF patient to the nephrologist may significantly improve the outcome.
| References|| |
|1.||Cameron JS. Acute renal failure in the intensive care unit today. Intensive Care Med 1986;12:64-70. [PUBMED] |
|2.||Groeneveld AB, Tran DD, van der Meulen J, Nauta JJ, Thijs LG. Acute renal failure in the medical intensive care unit: predisposing, complicating factors and outcome. Nephron 1991:59(4):602-10. |
|3.||Ledigham JG. Acute renal failure: etiology. The Islamic World Med J 1984;6:18-21. |
|4.||Said R. Acute renal failure in Jordan. Saudi J Kidney Dis Transplant 1998;9(3):301-5. |
|5.||Feest TG. Round A, Hamad S. Incidince of severe acute renal failure in adults: results of a community based study. BMJ 1993; 306: 481-3. |
|6.||Iglesias J, Lieberthal W. Acute renal failure. In: R. J. Johnson & J. Feehally. Comprehensive clinical nephrology. Spain. Mosby, Harcourt publishers limited, 2000; 4:15-20 . |
|7.||Chertow GM. On the design and analysis of multicentral trials in acute renal failure. Am J Kidney Dis 1977;30(5):596-601. |
|8.||Sulieman SM. Acute renal failure in Sudan. Saudi J Kidney Dis Transplant. 1998;9(3): 316-8. |
|9.||Rashed A, Aboud O, Addasi A, Taha M, ElSayed M, Ashour A. Acute renal failure: six months pilot study in Qatar. Saudi J Kidney Dis Transplant. 1998;9(3):298-300. |
Iqdam K Al-Taee
Consultant Nephrologist, Rasheed Hospital, P.O.Box 3712, Elwiya, Baghdad
[Table - 1], [Table - 2]