title: Acute posttraumatic renal failure: a multicenter perspective.
abstract: Acute renal failure (ARF) following trauma is rare. Historically, ARF has been associated with a high mortality rate. To investigate this entity we conducted a retrospective review of 72,757 admissions treated at nine regional trauma centers over a 5-year period. Seventy-eight patients (0.098%) developed acute renal failure requiring hemodialysis. Detailed demographic, clinical, and outcome data were collected. Patients with pre-existing medical conditions (group I) had a 70% increase in mortality over those without pre-existing conditions (p less than 0.004). Twenty-four patients (31%) developed ARF less than 6 days after injury (group II). The remainder (group III) developed late renal failure (mean time to first dialysis, 23 days). The predominant cause of death was multiple organ failure (82%). There were no differences in mortality because of multiple organ failure among the three groups of patients. Of the 33 survivors, six (18%) were discharged with renal insufficiency, three (9%) were discharged on dialysis, 23 (70%) were discharged home or to rehabilitation, and 27 (82%) had no significant evidence of renal insufficiency.
  
  
  CONCLUSIONS
  Posttraumatic renal failure requiring hemodialysis is rare (incidence, 107 per 100,000 trauma center admissions), but the mortality rate remains high (57%). Two thirds of the cases of posttraumatic renal failure develop late and are secondary to multiple organ failure; one third of the cases of posttraumatic renal failure develop early and may result from inadequate resuscitation.
authors.affiliation: Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: J A
authors.initials: JA
authors.lastname: Morris
authors.forename: P
authors.initials: P
authors.lastname: Mucha
authors.forename: S E
authors.initials: SE
authors.lastname: Ross
authors.forename: B F
authors.initials: BF
authors.lastname: Moore
authors.forename: D B
authors.initials: DB
authors.lastname: Hoyt
authors.forename: L
authors.initials: L
authors.lastname: Gentilello
authors.forename: J
authors.initials: J
authors.lastname: Landercasper
authors.forename: D V
authors.initials: DV
authors.lastname: Feliciano
authors.forename: S R
authors.initials: SR
authors.lastname: Shackford
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D000328:Adult; D005260:Female; D006801:Humans; D007239:Infections / Q000150:complications; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000150:complications*