Assessment of reversible risk factors causing acute-on-chronic renal failure.
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Date
2012-07
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Abstract
Summary: The present study was designed to evaluate the risk factors and their degree of reversibility in cases of acute-on-chronic
renal failure admitted to a tertiary care hospital over a period of one year, i.e., from November, 2006 to October, 2007.
Material: In this study 100 patients of acute-on-chronic renal failure (rise in serum creatinine of 0.5 mg/dl, if baseline serum
creatinine was < 3 mg/dl or rise of 1 mg/dl, if baseline was > 3 mg/dl within a one-week period) were included and various reversible
risk factor(s) and the degree of reversibility of renal failure was determined.
Methods: A thorough clinical evaluation and investigations of all patients was done and they were put on conservative management
along with specific management of reversible factor(s) and haemodialysis, whereever needed. The observations of various
parameters were recorded at presentation (baseline) and subsequently at 1 week and 2 week periods which included 24-hour
urine volume, blood urea, serum creatinine, and creatinine clearance. Reversibility of these parameters was then statistically
analysed. To compare the degree of reversibility, the patients were divided into 4 groups at the time of admission depending upon
their GFR; group 3 with GFR 30 - 59 ml/min, group 4 with GFR 15 - 29 ml/min, group 5a with GFR 5 - 15 ml/min, and group 5b with
GFR < 5 ml/min, respectively.
Results: Majority of patients were found to have more than one reversible risk factor. These were hyperuricaemia (89), electrolyte
imbalance (51), infection/sepsis (47), accelerated hypertension (21), volume depletion (18), urinary tract obstruction (16), and
hypotension (7). A considerable degree of reversibility was detected, maximum being in volume depletion and urinary tract
obstruction.
Conclusions: Therefore it was concluded that patients presenting in a severe uraemic state may not be suffering from ESRD and
each patient should be investigated for the presence of reversible risk factor(s) so that renal function can be restored and hence
the need of renal replacement therapy can be delayed.
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Keywords
Acute-on-chronic renal failure, reversible risk factors, chronic kidney disease, renal replacement therapy, degree of reversibility
Citation
Nand N, Shrama M, Kumar H, Mehta Prity. Assessment of reversible risk factors causing acute-on-chronic renal failure. Journal of Indian Academy of Forensic Medicine. 2012 July; 34(3): 210-213.