2019, Vol. 1, Issue 1, Part A

Aim: To study the clinical profile, pathogenic factors and outcome of patients with Acute Renal Failure who admitted in emergency room and intensive care unit.

Methods: This is a prospective, descriptive study carried out on patients with acute renal failure who admitted in emergency room and intensive care unit over a period of 22 months (January 2017– October 2018) at Government General Hospital, Guntur Medical College, Guntur. The clinical presentation, causative factors, medications, co-morbid conditions were analysed. Renal functions namely nitrogenous compounds in blood were monitored.

Results: During the study period, 2076 patients were attended either emergency room and/or intensive care unit. Among these, 11.85%(n=246) patients were detected to have ARF sometime during their stay in the hospital as defined by the study criteria. In total, 176 (71.54%) and 70 (28.54%) were male and female with mean age of the patients 53.47± 17.316 yrs. Medical causes of admissions in 59.75%cases, surgical causes in 36.99%, and obstetrical causes in 3.66%cases respectively. Pre-renal failure was observed in 202 (82.11%) patients and intrinsic and postrenal reported in 30(12.19%) and 14 (5.69%) patients respectively. Sepsis was the major contributing factor for ARF in 134 patients, followed by respiratory tract infections in 26, cellulitis in 11, diabetic foot in 11, Cirrhosis of liver in 5, snake bite in 4, Chrystanthis collinis poisoning in 2, Aminoglycoside exposure was in 6 cases two cases of hanging cases etc were noted. Benign Prostatic Hyperplasia (BPH) and calculus obstruction causes of post renal failure seen in 4 and 3 cases. Stricture urethra contributed to post-renal failure in 2 cases. A single case of carcinoma cervix with bilateral ureteric obstruction was noted. HELLP syndrome seen in 4 cases, neurosurgical causes were attributed as the cause of ARF in 32 patients. Gastrointestinal, general surgical and orthopedic causes were responsible in 20, 19 and 6 cases respectively. Sepsis was observed in 134 patients (54.47%), followed by tachypnoeic (36.99%), Hypoxia in 30 (12.19%), anuric in 20 (8.13%), and oliguria in 19 patients (7.72%). Anemia seen in 150 patients (60.98%), leukocytosis in 141 patients (57.31%), thrombocytopenia in 88 patients (35.77%), Hypernatremia in 31 (12.60%) and hyponatremia in 65 (24.62%), Hyperkalemia in 43 (17.47%), hypokalemia in 29 (11.79%) cases, metabolic acidosis in 59 patients (23.98%). Intermittent hemodialysis was done in 41 patients (16.67%). 153 patients were supported with mechanical ventilation (62.19%). Mean ICU days was 8 days, the total mean hospitalization was 12 days. 53 cases with ARF were died during hospital stay (21.54%), 103 patients (41.87%) were recovered, and 49 patients were discharged against medical advice (16.66%) and 33 were discharged at request (13.41%). Septic shock was the cause of death in 39 patients (73.58%), Cerebrovascular accidents death in 7 patients (13.21%) and cardiac causes in 7 patients (7.54%). The gender, thrombocytopenia, Glasgow coma scale score, and the basic cause of admission did not show statistically significant difference among survivors and non survivors.

Conclusion: Ventilator requirement, co-morbid illness, decreased urine output and sepsis were found to be significantly correlated with mortality in patients of acute renal failure admitted to emergency room and ICU in that order of importance. It is important to note that many patients were discharged prematurely from the hospital possibly due to social problems. Hence, guidelines regarding acute renal failure in the emergency are lacking and ARF practice from critical care department should be adopted.