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Saudi Journal of Kidney Diseases and Transplantation
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RENAL DATA FROM THE ARAB WORLD  
Year : 2011  |  Volume : 22  |  Issue : 4  |  Page : 829-833
Acute renal failure in Yemeni patients


Nephrology Department, Science and Technology University Hospital, Sanaa, Yemen

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Date of Web Publication9-Jul-2011
 

   Abstract 

Acute renal failure (ARF) is defined as a rapid decrease in the glomerular filtration rate, occurring over a period of hours to days. The Science and Technology University Hospital, Sana'a, is a referral hospital that caters to patients from all parts of Yemen. The aim of this study is to have a deeper overview about the epidemiological status of ARF in Yemeni patients and to identify the major causes of ARF in this country. We studied 203 patients with ARF over a period of 24 months. We found that tropical infectious diseases constituted the major causes of ARF, seen in 45.3% of the patients. Malaria was the most important and dominant infectious disease causing ARF. Hypotension secondary to infection or cardiac failure was seen in 28.6% of the patients. Obstructive nephropathy due to urolithiasis or prostate enlargement was the cause of ARF in a small number of patients. ARF was a part of multi-organ failure in 19.7% of the patients, and was accompanied by a high mortality rate. Majority of the patients were managed conservatively, and only 39.9% required dialysis. Our study suggests that early detection of renal failure helps improve the outcome and return of renal function to normal. Mortality was high in patients with malaria and in those with associated hepatocellular failure.

How to cite this article:
Al Rohani M, Aljawshaei H, Aduolimi E. Acute renal failure in Yemeni patients. Saudi J Kidney Dis Transpl 2011;22:829-33

How to cite this URL:
Al Rohani M, Aljawshaei H, Aduolimi E. Acute renal failure in Yemeni patients. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2019 Aug 21];22:829-33. Available from: http://www.sjkdt.org/text.asp?2011/22/4/829/82734

   Introduction Top


Yemen is a tropical country. Typical weather conditions and compromised public health standards impose a highly polluted bio-ecological environment, which leads to a high prevalence of both primary and secondary infections. Acute renal failure (ARF) is one of the most challenging diseases in tropical countries. Our hospital is located in the capital town, Sana'a, and, being a referral hospital, patients are admitted from different regions and provinces of the country. Many tropical diseases, such as infectious diseases and post-renal causes, play a major role in the occurrence of ARF in Yemen. The aim of this study is to have an epidemiological overview of the causes of ARF in Yemeni patients as well as the outcome of management.


   Methods Top


Between August 2006 and July 2008, we admitted 203 adult patients with ARF. Data pertaining to history and physical examination, including vital signs, were recorded; routine laboratory investigations, including complete blood count, blood chemistry, serological tests and radiological investigations, were reviewed. Only patients with ARF were included in the study. To establish the diagnosis of ARF, we used the commonly used definitions, including an increase in serum creatinine by ≥0.5 mg/dL over the base-line value, an increase of more than 50% over the base-line value, a reduction in the calculated creatinine clearance of 50% or a decrease in renal function that resulted in the need for dialysis as well as the presence of normal ultrasonography of kidney and normalization of serum creatinine after therapy, for patients who survived. Patients with pre-existing chronic renal failure were excluded from the study.


   Results Top


We studied 203 adult patients with ARF whose age ranged from 19 to 87 years. Of them, 83 patients (40.9%) were aged between 19 and 39 years. There was a male preponderance, with 79.3% being males [Table 1]. The most frequent cause of ARF was tropical infectious diseases seen in 47% of the patients, with malaria and sepsis being the common causes of ARF ([Table 2], [Figure 1]). ARF associated with renal hypoperfusion was found in 29.6% of the cases [Figure 2]. The serum creatinine at presentation ranged from 2.5 mg/dL to 21.3 mg/ dL, with a mean level of 7.2 mg/dL (± 0.5). The blood urea ranged from 100 mg/dL to 369 mg/dL, with a mean level of 110 mg/dL. Liver enzymes and bilirubin were elevated in patients with malaria, hepatocellular failure and sepsis. In patients with Falciparum malaria, the bilirubin levels, both total and direct, were elevated. Sepsis causing ARF occurred in 6.9% of all patients; the major causes were bacterial infection in all patients, while one patient had fungal infection, in addition. The source of septicemia was urinary tract infection seen in 57.1% of the patients, nosocomial infection seen in 28.6% and pneumonia seen in 14.3% of the patients.  Escherichia More Details coli (71.4%), Staphylococcus aureus (21.4%) and Pseudomonas aerugenosa (7.2%) were the common organisms isolated. The outcome of therapy and the various therapeutic modalities used are outlined in [Table 3] and [Figure 3].
Figure 1: Classification of causes of acute renal failure in the study patients.

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Figure 2: Causes of hypotension resulting in acute renal failure in the study patients.

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Figure 3: Map of management in the study patients.

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Table 1: Demographic features of our patient population.

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Table 2: Etiology of acute renal failure in the study patients.

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Table 3: Outcome of therapy in the study patients.

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   Discussion Top


During the two years of our study, we admitted 203 patients with ARF. Falciparum malaria was an important cause of ARF (29%), and heavy parasitemia was associated with different clinical features, including black water fever, cerebral involvement, cholestatic jaundice, non-cardiogenic pulmonary edema, shock and disseminated intravascular coagulation (DIC). Most affected patients presented with oliguric ARF and urine output less than 400 mL per 24-hours, while some patients presented with non-oliguric ARF or even with polyuria. ARF was usually seen at the end of the first week of infection, and presence of elevated bilirubin and long duration of oligoanuria were associated with high mortality. Chloroquinine resistance is commonly observed in Yemen and. thus, the drug of choice for malaria is quinine. It is important to avoid hypoglycemia and possible hypokalemia as serious complications of quinine. Dialysis was necessary for almost 50% of the patients with malarial ARF. Multiorgan failure was a serious problem in patients with oligoanuric malarial ARF with hepatic injury, cerebral encephalopathy and hypotension or irreversible shock; nine of this group (15%) died. Early diagnosis, proper selection of anti-malarial drugs and dialysis, if needed, are associated with good survival rate and good recovery of renal function. Sepsis was also a common cause of ARF, and 6.9% of the patients in this group had E. coli as the causative organism. Two patients in this group died. Patients with hepatorenal syndrome had serious outcome with high mortality, regardless of whether dialysis was administered or not. ARF due to obstructive causes were limited in our group, and had a better outcome due to early diagnosis, relatively mild increase in urea and creatinine as well as early and appropriate intervention.

Conventional intermittent HD was used for patients with normal blood pressure. Anemia was mostly found in patients with hemolysis, such as those with malaria, or in patients with bleeding. Correction of anemia is essential to avoid ischemic ARF.

Similar etiological factors for ARF, as seen in our study, were found in a study from southern Saudi Arabia; however, sepsis was the leading cause of ARF in that study, and malarial ARF was relatively less frequent. [1] In Sudan, malaria and typhoid were found to be the leading cause of ARF. [2] In Karachi, Pakistan, a study on 237 patients showed that malaria is a major cause of ARF as in our group, with similar clinical outcome. [3] Another study, also from Karachi by Malik Rabbani et al comprising 898 patients, showed that sepsis was the major cause of ARF seen in 25.4% of the patients, and carried a high mortality of 60%, while malarial ARF was seen only in 3.5%. [4] Riyad Said showed in his study that the major cause of ARF was gastrointestinal fluid losses and cardiological causes; malaria was not mentioned. Also, obstructive uropathy caused ARF in 14% of all his patients, most of whom were from Yemen and Sudan. [5] In comparison, in our study, only 4.9% had obstructive uropathy.

 
   References Top

1.Al-Homrany M. Epidemiology of acute renal failure in hospitalized patients: experience from southern Saudi Arabia. East Mediterr Health J 2003;9:5-6.  Back to cited text no. 1
    
2.Kaballo BG, Khogali MS, Khalifa EH, Khaiii EA, Ei-Hassan AM, Abu-Aisha H. Pattern of "Severe Acute Renal Failure" in a referral centre in Sudan: Excluding intensive care and major surgery patients. Saudi J Kidney Dis Transplant 2007;18(2):220-5.  Back to cited text no. 2
    
3.Abdul Manan J, Ali H, Lal M. Acute renal failure associated with malaria. J Ayub Med Coll Abbottabad 2006;18(4):47-52.  Back to cited text no. 3
    
4.Rabbani MA. Etiology of acute renal failure in tertiary centre. Saudi J Kidney Dis Transpl 2008;19(6):1009-14.  Back to cited text no. 4
    
5.Said R. Acute Renal Failure in Jordan. Saudi J Kidney Dis Transpl 1999;9(4):301-5.  Back to cited text no. 5
    

Top
Correspondence Address:
Muhamed Al Rohani
Nephrology Department, Science and Technology University Hospital, Sana'a -sixty St., P.O. Box 13061, Sanaa
Yemen
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PMID: 21743244

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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]

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