Acute renal failure in chronic kidney disease--clinical and pathological analysis of 104 cases.
BACKGROUND
Acute renal failure in chronic kidney disease (A/C) constitutes an important part of acute renal failure (ARF), but until now there has been no research focusing on this entity.


METHODS
Clinical data were collected from all patients diagnosed as A/C by clinical materials and renal biopsy over a 12-year period (January 1990 - December 2001) in the renal department of a teaching hospital, and the incidence, etiology, pathological and clinical features of A/C, and factors predicting prognosis were studied.


RESULTS
Altogether, 104 patients of A/C were identified, which accounted for 35.5% of biopsied acute renal failure cases during the same period. Drug-induced acute renal interstitial/tubular-interstitial disease, prerenal ARF and flare-up of lupus nephritis were the most common causes of ARF in A/C patients. More than one third of A/C were associated with drugs, which occurred more commonly in older patients. After an average hospitalization of 28.5 days, about 39 patients required dialysis, 23 patients became dialysis-independent. The mortality was 1.9%. Furthermore, serum creatinine (Scr) returned to normal level (< 133 micromol/l) in 46.2% of all patients; Scr decreased by 15%, yet not normal in 26.0%. Multivariate logistic regression analysis indicated that hypertension, requirement of dialysis therapy and high Scr level were independent predictors of poor renal outcome.


CONCLUSIONS
A/C constitutes an important part of ARF, and drug-induced ARF is prominent in China. Because early diagnosis and correct treatment may obviously affect prognosis, enough attention should be paid to this entity.
Zhang
L
L
Division of Nephrology, Peking University First Hospital, Beijing, China.
Wang
M
M
Wang
H
H
D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate