[Severe sepsis as a cause of acute renal failure].
BACKGROUND
The most common causes of acute renal failure in the intensive care units are severe sepsis and septic shock. Mortality reported in this kind of patients is about 70%. The pathophysiology of acute renal failure in severe sepsis includes systemic hypotension, direct renal vasoconstriction, infiltration of the kidney by inflammatory cells, renal ischemia, intraglomerular thrombosis and intratubular obstruction.


OBJECTIVE
To show the incidence, mortality and histopathological etiology of acute renal failure in severe sepsis. TYPE STUDY: Retrospective, transversal and descriptive.


METHODS
We study 332 cases of patients with severe sepsis, who were hospitalized in the Intensive Care Unit of Hospital General del Centro Médico Nacional, during five years. From these patients 107 developed acute renal failure due to severe sepsis. This group recived two differet kind of treatment, medical management (70%) and hemodyalisis (30%). Renal biopsy was taken in 40 patients after six or seven days of the diagnosis of acute renal failure caused by severe sepsis.


RESULTS
In the group of 332 patients with severe sepsis 107 developed acute renal failure, this represents the 32.22%. The group of patients with renal biopsy presented the following results: 50% had acute tubular necrosis, 27.5% presented glomerular and tubular lesion, the rest 22.5% had glomerular and vascular lesion. The mortality for patients treated with medical management was of 69.3%, and for those treated with hemodyalisis was of 28.1%.


CONCLUSIONS
Nowadays, and due to the high incidence and mortality of this disease, is very important to generate more concise knowledge about the genesis and development of acute renal failure in the septic patient.
Díaz de León
M
M
Académico Emérito de la Academia Mexicana de Cirugía, Académico titular de la Academia Nacional de Medicina. manueldeleoponce@hotmail.com
Moreno
S A
SA
González Díaz
D J
DJ
Briones
G J
GJ
D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology*; D003430:Cross-Sectional Studies; D006801:Humans; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications*; D012720:Severity of Illness Index