膀胱内灌注丝裂霉素C致肾功能衰竭2例报告

目的：探讨膀胱腔内灌注丝裂霉素C（MMC）导致肾功能衰竭的原因。方法：回顾性分析我院收治的2例因膀胱内灌注MMC导致肾功能衰竭的发生及发展过程。结果：2例患者均因膀胱挛缩，形成膀胱输尿管及肾反流，导致肾功能衰竭。结论：反流形成是发生肾功能衰竭的解剖学基础，丝裂霉素的吸收量增加及其毒副作用是肾功能衰竭的直接因素。     

重症急性胰腺炎合并急性肾功能衰竭54例临床分析

目的分析重症急性胰腺炎（SAP）合并急性肾功能衰竭（ARF）的临床特点及其预防和治疗。方法回顾分析南京军区南京总医院1997年1月至2005年4月收治的503例SAP中合并ARF的54例病人的临床资料，并用直线回归（逐步回归）方法，对影响SAP合并ARF的发生率及病死率的相关因素进行分析。结果SAP合并ARF的发生率为10．7％，病人的年龄、SIRS（全身炎症反应综合征）持续时间、病情严重程度（APACHEⅡ评分、CT评分）、ARDS（急性呼吸窘迫综合征）、MODS（多器官功能障碍综合征）、ACS（腹腔间室综合征）、感染及局部并发症等因素对ARF的发生有显著的影响；54例中，死亡18例（33．3％），同时合并ARDS和MODS是增加病人病死率的重要原因。是否伴有胰周感染对病人的病死率影响不显著。结论早期液体复苏、控制病情发展、维护重要脏器功能及积极有效的引流是预防SAP并发ARF，改善预后的重要手段。     

心脏术后急性肾功能衰竭

急性肾功能是心脏术后常见而严重的并发症，是患者死亡率增加的独立危险因素，探讨心脏术后发生ARF的危险因素，并积极预防和治疗是近年来研究的热点之一，本文就心脏术后发生急性肾功能衰竭的相关因素、治疗和预后等问题的临床研究进展作一综述。     

脓毒症的急性肾损伤

脓毒症是危重病患者的常见病因或并发症，也是大家熟知的引起急性肾损伤（AKI）和多脏器功能障碍综合征（MODS）的常见危险因素。急性肾功能衰竭（ARF）发生率在一般脓毒症患者约为19％；在重度脓毒症约为23％；在血培养阳性的脓毒症休克者可高达51％。ARF并发脓毒症的病死率高达70％，明显高于无并发脓毒症的45％。因此，研究并了解AKI和脓毒症的相互关系和作用机制，将有助于降低脓毒症时AKI的高发病率以及相关的高器官衰竭率和病死率。     

心脏术后急性肾功能衰竭

急性肾功能衰竭是心脏术后常见而严重的并发症 ,是患者死亡率增加的独立危险因素 ,探讨心脏术后发生ARF的危险因素 ,并积极预防和治疗是近年来研究的热点之一 ,本文就心脏术后发生急性肾功能衰竭的相关因素、治疗和预后等问题的临床研究进展作一综述     

背驮式肝移植的术中容量管理

肝移植术后早期急性肾功能衰竭（post-operation earlystage acute renal failure，以下简称ARF）是常见而严重的并发症。背驮式肝移植术中血流动力学稳定，术后肾功能衰竭并发症罕见。自2003年9月至2005年9月我院共做背驮式肝移植手术30例，本文回顾性分析术中的容量管理的特点及术后早期ARF发生情况，并探讨处理策略。     

急性肾损伤诊断与分类专家共识

近几十来．临床和基础的研究工作者们针对急性肾功能衰竭（ARF）进行了广泛的研究，尽管我们在该疾病的生理和发病机制方面都取得了长足的进步，但如何将这些知识用于临床，改进ARF患者预后方面的工作却做得十分有限。ARF是由多种病因导致、可发生在各种临床情况之下（儿童或成人、门诊或住院、ICU或非ICU患者）的一种复杂的肾功能紊乱，其临床表现既可以是血肌酐水平的轻微升高，也可以是无尿性肾功能衰竭。     

梗阻性黄疸高胆红素血症与急性肾功能衰竭关系探讨

急性肾功能衰竭(acute renal failure,ARF)是梗阻性黄疸(obstructive jaundice,OJ)术后常见并发症,且死亡率极高[1],因此对急性肾功能衰竭重点在于预防。导致术后急性肾功能损害的因素很多,本研究回顾性分析梗阻性黄疸患者的胆红素因素对急性肾功能损害的影响,为临床工作中预防和减少发生类似并发症提供参考依据。     

320例急性肾功能衰竭患者的临床分析

目的 探讨急性肾功能衰竭（ARF）住院患者的病因、预后及影响预后的因素。 方法 回顾性研究我院2003年12月至2006年12月期间急性肾功能衰竭患者的临床资料。 结果 观察期间住院患者共108 744例次，其中ARF患者320例，老年ARF患者135例，占42.2%。ARF主要病因为感染、心力衰竭和药物。ARF患者总体病死率为31.9%，老年人病死率较高。Logistic回归分析显示心力衰竭、呼吸衰竭及恶性肿瘤是与预后相关的危险因素。接受肾替代治疗组患者病死率低于保守治疗组（23.2％比35.6％，P < 0.05）。 结论 住院患者中ARF的发生率、病死率高，替代治疗组预后较好。     

危重病人急性肾功能衰竭的管理

危重病人易发生急性肾功能衰竭(ARF),且ARF是导致危重病人死亡的独立危险因素.ARF管理的目的是提高病人的治愈率和生存率,主要包括:①对有发生ARF高危因素的人群尽早介入、早期预防和早期诊断;②阻断ARF发生后的持续损伤;③并发症的预防和管理;④ARF病人的营养问题;⑤肾脏病理学检查和多学科协作管理.     

Acute renal failure related to open-heart surgery

Open-heart surgery was performed on 1686 adult patients between 1980 and 1984. The patients were operated on using cardiopulmonary bypass procedures (CPB). Fifteen patients developed acute renal failure (ARF) after CPB, i.e. the incidence of ARF was 0.9%. All these patients were treated by peritoneal dialysis or haemodialysis. Pre-operative possible risk factors in the ARF group were compared to those in a control group of 30 patients (15 consecutive coronary artery bypass grafting and 15 consecutive valve repair procedures) experiencing no complications. Age, New York Heart Association (NYHA) classification, ejection fraction, cardiac volume and left ventricular end-diastolic pressure were not risk factors for the development of renal failure. The incidence of thrombocytopenia after CPB was statistically significantly different between the control and ARF groups. The mortality from ARF was 66.6%. The causes of death were peri-operative myocardial infarction, infection and gastrointestinal bleeding. CPB time, perioperative events and postoperative infection were the main factors contributing to ARF. Renal failure was twice as common in valve procedures as in coronary artery revascularization procedures. Impairment of renal function proved reversible only in those patients who survived. After restoration of renal function the prognosis was good.     

Trends in Cardiac Surgery-Associated Acute Renal Failure in the United States: A Disproportionate Increase after Heart Transplantation

Acute renal failure (ARF) is common after cardiac surgery and more frequent after complex cardiac surgery. While the incidence of ARF is increasing after coronary artery bypass graft (CABG) surgery, trends in other forms of cardiac surgery remain unclear. We investigated the trend of ARF in various cardiac procedures and compared patterns using CABG surgery as a reference group. The study population consisted of discharges from the Nationwide Inpatient Sample from 1988 to 2003, grouped according to surgery as: CABG, CABG with mitral valve, CABG with other valve, valve alone, and heart transplant. Standard diagnostic codes were used to identify ARF among discharges. Multivariable regression was used to determine trends in ARF among various procedures with CABG as a reference group. The incidence of ARF increased in all five groups (p < 0.001) over the 16-year period. The ARF incidence was highest in the heart transplant group (17%). Compared to the CABG population, patients following heart transplantation developed ARF at higher rates during the study period. In contrast, while ARF increased over time in other groups, the rates of rise were slower than in CABG patients. Among heart surgery procedures, ARF incidence is highest in heart transplantation. The incidence of ARF is also increasing at a faster rate in this group of patients in contrast to other procedure groups when compared to CABG surgery. The disproportionate increase in ARF burden after heart transplantation is a concern due to its strong association with chronic kidney disease and mortality.     

Renal tubular impairment after surgery

It is well known that acute renal failure (ARF) after surgery has a high mortality rate. The purpose of this paper is to clarify the renal tubular damage following surgery. Urinary beta 2 microglobulin (u-BMG) and urinary N-acetyl-beta-D-glucosaminidase (u-NAG) activities, thought to be the sensitive indicators of renal tubular impairment, were measured in 48 patients treated surgically in our clinic. Three out of 48 patients developed ARF. Remaining 45 showed normal values in conventional renal function tests, while u-BMG and u-NAG revealed abnormally high levels in many cases. Bleeding amount during surgery, operative time, postoperative complications, especially circulatory shock, and preoperative hypotention were the factors which correlated closely to the elevation of u-BMG and u-NAG. Administration of urinastatin prevented the u-NAG elevation postoperatively, while it had no effect on u-BMG.     

Acute renal failure in the medical intensive care unit: predisposing, complicating factors and outcome.

The factors predisposing to and complicating acute renal failure (ARF) in the medical intensive care unit (ICU), and their relative influence on outcome during ARF are unclear. We retrospectively evaluated the relative importance of age, prior chronic disease (including chronic renal failure), sepsis and organ system failure, for development and outcome of ARF in the medical ICU. Of 487 consecutively admitted patients, 78 (16%) had ARF, in 63% treated with renal replacement therapy. Mortality was 63%. Independently from each other, advancing age, prior chronic disease, and cardiovascular and pulmonary failure directly related to the development of ARF, while neurological failure related inversely. Sepsis only contributed to ARF prediction from these variables if cardiopulmonary failure was excluded. Advancing age, cardiovascular failure before and after onset of ARF, pulmonary failure before ARF and use of renal replacement therapy were the major independent factors directly related to ARF mortality, while prior chronic renal failure related inversely and sepsis did not contribute. Hence, the outcome of ARF in a medical ICU is largely dependent on factors predisposing to ARF, even though the severity and complications of ARF may partly contribute. Our results may help in deciding on the prevention and therapy of ARF in a medical ICU.     

Risks of acute renal failure after cardiopulmonary bypass surgery in children: a retrospective 10-year case-control study

To our knowledge there are no case-control studies that haveexamined the main risk factors for acute renal failure (ARF)following cardiopulmonary bypass surgery in children. We thereforeevaluated the potential risk factors in a large retrospectivecase-control study. Sixty-one of 2262 children (2.7%) developedpostcardiopulmonary bypass surgery ARF requiring peritonealdialysis (PD) from 1982 to 1991. Fifty-eight of 61 cases (medianage 8.5 months) were selected by systematic sampling and matchedwith 176 controls who did not develop ARF. The four matchingvariables were age, cardiopulmonary bypass and circulatory arrestduration, and year of operation. Mortality rate was 79% in cases (controls: 18%). Forty-threeof 48 of the deceased cases did not recover renal function;no renal cause of death was found; 13 of 61 cases survived andrecovered renal function. Multiple regression analysis showedthe following significant risk factors for postcardiopulmonarybypass surgery ARF: central venous hypertension >12 h (oddsratio (OR) 9.6); systolic arterial hypotension >12 h (OR8.9); dopamine dosage >15 µg/kg/min (OR 3.0); adrenaline(OR 5.9) and isoproterenol (OR 13.5) use. High preoperativeserum creatinine, cyanosis, and vasodilator use were not significantrisk factors. We conclude that: (1) haemodynamic alterations were the maincause of postcardiopulmonary bypass surgery ARF; (2) ARF wasassociated with but was not the cause of the high mortalityrate; (3) the risk of ARF increased almost 10-fold after 12h of central venous hypertension and/or of systolic arterialhypotension; (4) effective dosages of inotropes might have beena risk factor for ARF; (5) a slight precardiopulmonary bypasssurgery reduction of renal function alone did not representan increased risk for ARF.     

Acute changes in renal function after laparoscopic gastric surgery for morbid obesity.

BACKGROUND: Acute renal failure (ARF) is a serious complication that contributes to patient morbidity and may result in death. To date, no data are available regarding the predictive risk of ARF or its effect on the outcome of patients who undergo laparoscopic gastric bypass. METHODS: The medical records of 1800 patients who underwent gastric bypass from July 1997 to July 2003 at a single institution were analyzed. The data collected included demographics, comorbid factors, operative details, and postoperative outcomes. Multivariant analysis was performed and the results were compared with those of 500 age-, gender-, and comorbidity-matched control patients who underwent similar operations. RESULTS: The mean age was 50 +/- 8 years; 23 were men and 19 were women. Of the 1800 patients, 42 (2.3%) developed ARF after surgery. Dialysis was required in 6 patients, 2 of whom became dialysis dependent. ARF completely resolved in the remaining patients. CONCLUSION: Primary ARF after laparoscopic gastric bypass is an uncommon complication, with an incidence of 2.3% in our institution. Patients with a body mass index >50, previous chronic renal failure, and long operating times and intraoperative hypotension are at the greatest risk of postoperative renal failure. All patients who had normal renal function preoperatively returned to normal renal function within 6 months.     

败血症并发急性肾功能衰竭患者的临床特点和影响预后的因素

目的：探讨败血症伴急性肾功能衰竭（ARF）患者的临床特点和影响预后的因素。方法：回顾分析近10年败血症ARF患者的临床资料，分别计算APACHE Ⅱ和ATN－ISI积分，并与非败血症ARF进行对比，运用多因素回归分析观察由败血症引起ARF的临床和主要生化指标与预后的关系。结果：败血症并发ARF者66例，占同期ARF患者的15．6％。多脏器衰竭发生率为87．9％，病死率高达69．7％。单因素分析发现外科原因的败血症、并发呼吸衰竭、肝功能衰竭、辅助呼吸、少尿、昏迷、多脏器衰竭、在ICU中出现ARF以及慢性疾病数目为影响其预后的因素。多因素logistic回归分析结果显示少尿、在ICU中出现的ARF、慢性疾病数目和多脏器衰竭为其独立危险因素。结论：败血症所致ARF患者预后差，其高病死率与少尿，在ICU中出现ARF、合并慢性疾病数目和多脏器衰竭有关。     

Risk factors for acute respiratory failure in bariatric surgery: data from the Nationwide Inpatient Sample, 2006–2008

BackgroundAcute respiratory failure (ARF) can be a life-threatening postoperative complication after bariatric surgery and is defined as the presence of acute respiratory distress or pulmonary insufficiency. We sought to identify predictors of ARF in patients who underwent bariatric surgery.MethodsUsing the Nationwide Inpatient Sample database, from 2006 to 2008, the clinical data from morbidly obese patients who underwent bariatric surgery were examined. Multivariate regression analysis was performed to identify the independent factors predictive of ARF. The factors examined included patient characteristics, co-morbidities, payer type, teaching status of hospital, surgical techniques (laparoscopic versus open), and type of bariatric operation (gastric bypass versus nongastric bypass).ResultsA total of 304,515 patients underwent bariatric surgery during the 3-year period. The overall ARF rate was 1.35%. The greatest rate of ARF (4.10%) was observed after open gastric bypass surgery. The ARF rate was lower after laparoscopic than after the open surgical technique (.94% versus 3.87%, respectively; P < .01) and after nongastric bypass versus gastric bypass (.82% versus 1.54%, respectively; P < .01). Using multivariate regression analysis, congestive heart failure (adjusted odds ratio [AOR] 5.1), open surgery (AOR 3.3), chronic renal failure (AOR 2.9), gastric bypass (AOR 2.5), peripheral vascular disease (AOR 2.4), male gender (AOR 1.9), age >50 years (AOR 1.8), Medicare payer (AOR 1.8), alcohol abuse (AOR 1.8), chronic lung disease (AOR 1.6), diabetes mellitus (AOR 1.2), and smoking (AOR 1.1) were factors associated with greater rates of ARF. Compared with patients without ARF, patients with ARF had significantly greater in-hospital mortality (5.69% versus .04%, P < .01).ConclusionWe identified multiple risk factors that have an effect on the development of acute respiratory failure after bariatric surgery. Surgeons should consider these factors in surgical decision-making and inform patients of their risk of this potentially life-threatening complication.     

A clinical score to predict acute renal failure after cardiac surgery

The risk of mortality associated with acute renal failure (ARF) after open-heart surgery continues to be distressingly high. Accurate prediction of ARF provides an opportunity to develop strategies for early diagnosis and treatment. The aim of this study was to develop a clinical score to predict postoperative ARF by incorporating the effect of all of its major risk factors. A total of 33,217 patients underwent open-heart surgery at the Cleveland Clinic Foundation (1993 to 2002). The primary outcome was ARF that required dialysis. The scoring model was developed in a randomly selected test set (n = 15,838) and was validated on the remaining patients. Its predictive accuracy was compared by area under the receiver operating characteristic curve. The score ranges between 0 and 17 points. The ARF frequency at each score level in the validation set fell within the 95% confidence intervals (CI) of the corresponding frequency in the test set. Four risk categories of increasing severity (scores 0 to 2, 3 to 5, 6 to 8, and 9 to 13) were formed arbitrarily. The frequency of ARF across these categories in the test set ranged between 0.5 and 22.1%. The score was also valid in predicting ARF across all risk categories. The area under the receiver operating characteristic curve for the score in the test set was 0.81 (95% CI 0.78 to 0.83) and was similar to that in the validation set (0.82; 95% CI 0.80 to 0.85; P = 0.39). In conclusion, a score is valid and accurate in predicting ARF after open-heart surgery; along with increasing its clinical utility, the score can help in planning future clinical trials of ARF.     

心脏术后低排综合征致急性肾功能衰竭的腹膜透析治疗

目的　探讨腹膜透析对心脏术后低排综合征 (LOS)致急性肾功能衰竭 (ARF)的疗效。方法　 2 4例心脏术后引起LOS合并多脏器功能衰竭 (MSOF)致ARF者 ,因不适合血液透析 (HD) ,于确诊后 2 4小时内进行腹膜透析 (PD)治疗。结果　 12例患者多脏器严重衰竭死亡 ,9例患者PD 3～30天内肾功能恢复 ,3例治疗后病情好转 ,自动出院。结论　心脏术后LOS致MOSF合并有ARF者 ,PD具有较好的治疗效果。