老年住院患者急性肾衰竭的临床分析

目的探讨65岁及以上老年人急性肾衰竭(ARF)的特点、病因、预后及其相关因素。方法收集我院1995年1月至2005年12月11年间诊断的老年ARF共150例,统计分析老年人ARF的特点、病因、预后及其相关影响因素。结果老年人ARF占同期全部ARF患者总数33%,老年人医院内获得性ARF(HA-ARF)的发生率为54%,明显高于社区获得性ARF(CA-ARF,P<0.05)。老年ARF的发生有逐年增高的趋势。老年ARF以肾前性ARF为主,多因素综合病因分析显示:与感染(56%)相关为首位病因,其次与低血容量(30.7%)、肿瘤(26%)、心功能衰竭(25.3%)、肾毒性药物(22%)、手术(14%)、肾脏疾病(14.7%)及肾后性疾病(8.7%)相关。单因素病因分析显示与低血容量相关为首位病因(21.6%)。老年ARF多由多种病因共同导致,其死亡率高达53.3%,HA-ARF死亡率是CA-ARF死亡率的1.87倍。结论老年人易患ARF。HA-ARF的增多是主要原因。感染、低血容量、肿瘤、心功能衰竭、肾毒性药物及手术是老年人ARF的常见原因。加强原发病的整体治疗,尽早发现并治疗ARF,有助于改善预后。     

Continuous arteriovenous hemofiltration in the elderly patients

The outcome of continuous arteriovenous hemofiltration (CAVH) treatment was evaluated in fifty one critically ill elderly with acute renal failure (ARF). They were admitted into our University Hospital's intensive-care units (ICU) during January 1987 and December 1990. Mean age (± SD) was 70.7 ± 5 (range 65–84) years. Elderly patients (>65 years old) comprised 44% of the ICU-ARF patients. The causes of ARF were cardiac surgery (41%), medical (31%), aneurysm of the resection of abdominal aorta (20%), and general surgery (8%). In the majority of the patients ARF was complicated by multiple organ failure. A survival of 60% was obtained with CAVH treatment. The highest survival rate (69%) was noted among cardiac surgery ARF patients, while the lowest survival (25%) was seen among patients with ARF following aneurysm of the resection of abdominal aorta. From the results of this study we conclude that CAVH serves a benificial role if it is considered in the management of ARF in the elderly intensive care patients with multiple organ failure.     

Changing patterns and outcome of acute renal failure requiring hemodialysis

To identify factors that may explain the persistently high mortality of acute renal failure (ARF), we compared the cause, clinical course, and outcome of 55 consecutive patients with ARF who underwent hemodialysis (HD) from 1962 to 1969 with 46 similar patients from 1979 to 1981 at the same medical center. We noted an overall increase in mortality from 54.5% to 71.7%. There was an increase in the number of elderly patients developing ARF, but age per se did not influence survival. There was a significant increase in mortality in younger patients resulting from the severity of their underlying illness. We saw an increase in the number of complicating factors occurring at the onset of ARF that correlated with the increase in mortality. In survivors ARF was more prolonged in our most recent experience. The development of prolonged, complicated ARF and the poor survival seen in younger patients led to the increase in mortality in our patients.     

257例儿童急、慢性肾功能衰竭的病因分析

目的 :了解儿童急、慢性肾功能衰竭的常见病因及构成比例。方法 :回顾分析近十年间 2 5 7例住院儿童急、慢性肾功能衰竭的临床资料 ,以及部分肾组织病理结果。结果 :急性肾功能衰竭(ARF)占住院病例总数的 8.0 2 %,慢性肾功能衰竭 (CRF)占 2 .0 3%;ARF病例以急性肾小球肾炎最为常见 ,占 5 9.0 2 %;CRF病例以肾髓质囊性病最为常见 ,占 32 .6 9%。结论 :儿童急、慢性肾功能衰竭病因的构成比例与现有的文献资料有差异 ,反映了本地区儿童肾功能衰竭有关病因的分布状况。     

老年内科危重症患者急性肾衰竭的临床分析

目的 了解老年内科危重症患者发生急性肾衰竭(ARF)的致病因素及转归.方法 对我院内科近10年老年(≥60岁)ARF患者的临床资料进行回顾分析,将老年患者分为院外获得性ARF(院外ARF)组和院内获得性ARF(院内ARF)组,并与同期内科非老年ARF患者进行比较.结果 (1)老年内科ARF患者381例,院外获得性ARF为218例(57.2%),医院获得性ARF为163例(42.8%),其中来自内科重症监护室153例(93.9%);(2)与院外ARF组比较,院内ARF组患者年龄较高.慢性基础疾病较多,伴发感染和/或心力衰竭的比率和病死率较高,ARF的程度较重;(3)院内ARF组的致病因素以感染及心力衰竭或心肌缺血为主;(4)院内ARF组死亡147例,死亡组伴慢性基础疾病、合并严重感染及心力衰竭、伴发老年多器官功能障碍综合征(MODS)者均多于存活组,危霞症程度(APACHEⅡ评分)更高,肾衰竭程度更重;(5)与非老年组比较,老年组院内ARF构成比、伴发MODS、APACHEⅡ评分及病死率均显著增高. 结论 老年危重症患者更易发生ARF,医院获得性ARF的主要诱因为感染,心力衰竭或严重心肌缺血,病死率较高.     

Renal failure after operation for abdominal aortic aneurysm in elderly patients

Acute renal failure (ARF) after operation for abdominal aortic aneurysm continues to be a serious complication with a poor prognosis. Though the incidence of ARF has declined during the last decade, the mortality has remained unchanged. The major cause of ARF is hypotensive episodes perioperatively or in the immediate postoperative period. Other etiologies are renal microembolization and clamping/declamping of the aorta close to the renal arteries. In patients above 70 years of age ARF is a serious complication and often associated with multiorgan failure. In most studies the mortality of patients with ARF ranges from 50% to 75%.     

Incidence and prognosis of acute renal failure in older patients

Few studies have assessed the prevalence and outcome of acute renal failure (ARF) in the elderly. Among 437 ARF cases prospectively studied during a nine-year period in a nephrology department, 152 (35%) occurred in patients over 70 years of age (Group 1). Patients over 70 account for only 10.5% of all hospital admissions in our country, and prevalence of ARF was 3.5 times higher in these patients than in younger people. Acute tubular necrosis (ATN) was diagnosed in 40% of Group 1 and 52% of the younger patients (Group 2) (P less than .05), whereas prerenal ARF was found in 47% and 32%, respectively (P less than .001). Dehydration was the most frequent cause of prerenal ARF in the elderly (51%). The etiological distribution of ATN was similar in both groups, being of multifactorial origin in most cases. Oliguria was present in 49% of ATN in Group 1 and in 66% of Group 2 (P less than .05). There were no significant differences in dialysis needs. Mortality was higher in the elderly in all types of ARF, although differences did not reach statistical significance. Need for dialysis, mechanical respiration, decreased level of consciousness, and hypotension were associated with poor prognosis in both groups. Total recovery from ARF in older persons was less frequent and slower than in younger patients. It may be concluded that patients over 70 years of age are at high risk for developing ARF; nevertheless, age should not be used as a discriminating factor in therapeutic decisions concerning ARF.     

Acute renal failure in patients with hematologic neoplasms

The retrospective study of acute renal failure (ARF) in patients with hematologic neoplasms was carried out. ARF occurred in 32 (6.1%) of 526 patients with hematologic neoplasms. Twenty-one (66%) patients recovered from ARF, but only 7 (22%) survived and were discharged from the hospital and 25 (78%) died of ARF or other complications. In 17 patients with leukemia or malignant histiocytosis, sepsis and/or disseminated intravascular coagulation were the most common causes of ARF, and all 17 patients died. In 11 patients with multiple myeloma, ARF was always attributable to the underlying disease, and the clinical course improved with the initiation of blood purification therapy (hemodialysis, plasma exchange) and chemotherapy. Five patients in blast crisis of chronic myelogenous leukemia or non-Hodgkin's lymphoma developed ARF as a result of tumor lysis syndrome. In this group, renal function improved with hemodialysis but only 2 patients survived. Patients with oliguria had worse outcomes than those without oliguria. Survival appeared to depend not on renal function but on the underlying disease, the cause of ARF, and other complications. These findings suggest that, in patients with hematologic neoplasms complicated by ARF, early initiation of blood purification therapy will improve the prognosis.     

Acute renal failure: a study of elderly patients

Two hundred and forty-six patients over the age of 65 years treated for acute renal failure (ARF) between 1960 and 1987 are reviewed. Although the fatality has apparently not changed over the duration of the study, it is possible to identify groups with a relatively good prognosis with renal replacement therapy. This particularly applies to patients with an underlying medical illness or with urological problems (excluding neoplasia). ARF following surgery with perioperative sepsis continues to carry a poor prognosis. We would recommend early referral of elderly patients with acute renal failure to a specialist unit, as a substantial proportion of survivors will regain normal renal function and quality of life.     

连续性肾脏替代疗法在重症急性肾功能衰竭治疗中的应用

目的 回顾分析连续性肾脏替代疗法（ＣＲＲＴ）在重症急性肾功能衰竭（ＡＲＦ）治疗中的应用和影响预后的因素。方法 １９８６年５月至１９９９年１月用ＣＲＲＴ治疗重症ＡＲＦ患者１０１例,回顾性分析了患者临床特点、ＣＲＲＴ方法和预后。结果 １０１例患者中６０例（５９．４％）度过疾病的急性期（存活组）,４１例（４０．６％）在急性期死亡（死亡组）,对两组患者的临床统计学资料、肾功能衰竭的特点、疾病严重程度（ＡＰ     

Acute renal failure in elderly patients

Patients' age and severity of renal insufficiency are important factors in the prognosis of ARF. We analysed, retrospectively, 66 patients over 65 years of age with ARF and requirement of renal function replacement. Mean age was 74.8±7 years. The etiologies of ARF were: obstructive (59%), medical (32%) and surgical (9%). Univariate analysis was undertaken. Hypotension (p=0.005), left ventricular failure (p=0.03), bleeding diathesis (p=0.007) and gastrointestinal haemorrhage (p=0.01) affected prognosis adversely. Mortality was directly related to the number of risk factors (p=0.001) and to the etiology of ARF-obstructive disease had a favorable prognosis (p=0.001). The overall mortality was 34.8% and the main causes of death were cardiovascular (30.4%) and infection (26.1%). Although it is important to define prognostic factors, old age should not be used as a criterion to refuse an opportunity of therapy in ARF.     

Activity in a nephrology ward in 2009, Piemonte, Italy

The characteristics of patients hospitalized in nephrology wards in Italy have changed in recent years due to the aging Italian population and the increased immigration. We analyzed the demographic and clinical characteristics of patients hospitalized in our nephrology ward (17 beds) from 15 November 2008 to 15 November 2009. In this period there were 507 hospitalizations including 448 patients. The mean age was 64.4+/-18 years (range 16-96 years). Foreigners accounted for 10% of the total; their mean age was significantly lower than that of Italian patients (38.2+/-13.4 vs 67.4+/-15.9 years, p<0.01). 36.3% of patients were on dialysis, 10% were transplant recipients: the reasons for admission in these cases were internal medicine related; 18.15% were hospitalized because of emergency unit crowding without indications for admission to a nephrology ward. Hospitalization lasted a mean of 13+/-13 days. The most frequent diagnosis at discharge was acute renal failure (ARF) (28.9%) (prerenal 42.1%, obstructive 12.2%, drug induced 6.8%, other causes of ARF 38.7%). Patients with ARF were older than patients with other kidney conditions (67.05+/-16.98 vs 56.03+/-18.65 years, p<0.01). ARF resolved or improved in 86 patients (63.7%). Other diagnoses were cardiovascular disease 25.1%, glomerular disease 18.7%, acute pyelonephritis 10.6%, other 16.7%. Foreign patients presented infectionrelated diseases more often than Italian patients (39.2% vs 20.4%, p=0.02). 392 patients were discharged to their homes, 40 (7.9%) found a place in a long-term care facility or home for the elderly, 25 (4.9%) in other hospital units, and 50 patients died (9.8%). In conclusion, patients hospitalized in nephrology wards in 2009 were mostly elderly with a high frequency of cardiovascular disease and diabetes. The most frequent diagnosis was prerenal ARF. These data suggest the necessity of improving the prevention of this type of kidney disease. Moreover, the length of hospitalization, which is increasing because of difficult clinical and social situations, could be shortened if more nursing homes, convalescent homes and homes for the elderly were available in Italy.     

Acute respiratory failure in adult patients with dengue virus infection

To investigate clinical course and outcome of dengue with acute respiratory failure (ARF), and to identify related risk factors for acquiring ARF in dengue, we retrospectively studied 11 dengue patients with ARF. From June to December 2002, a total of 606 adult patients were diagnosed as having dengue. Eleven (1.8%) of 606 dengue patients had complications of ARF. The main causes of ARF were sepsis (n = 6, 54.5%) and upper gastrointestinal (UGI) bleeding (n = 3, 27.3%). The mortality rate was 72.7% (n = 8). Additionally, univariate analysis showed that age, dyspnea, cough, prothrombin time, activated partial thromboplastin time, aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, creatinine, albumin, renal insufficiency, acute renal failure, acute hepatic failure, UGI bleeding, and combination bacterial infection were significantly predictive variables associated with dengue patients with ARF.     

A review of the pathophysiology,causes and prognosis of acute renal failure in the elderly

This paper reviews some of the pathophysiological, causal and prognostic aspects of acute renal failure (ARF) in the elderly patient. In the discussion on the factors predisposing the aged kidney to acute insults, the hypothesis is advanced that impairment of the autoregulatory capacity of renal blood flow and glomerular filtration rate plays a major role in the pathophysiology of ARF in the elderly patient. Recent data suggest that the relative increase of elderly patients in the overall population of patients with ARF can only partly be explained by the absolute increase of aged people. The major causes of ARF in the elderly are discussed. They show the same spectrum of etiologies of ARF as younger patients but within that spectrum, a significantly higher incidence of acute prerenal failure, iatrogenic hemodynamically-mediated ARF, renal vascular syndromes, glomerulonephritis, and post-ischemic acute tubular necrosis is observed. As far as the severity of the prognosis of ARF in the elderly is concerned, the review of published data does not allow definite conclusions on this subject. The main reason is the lack of information in a form that allows an easy and meaningful comparison. The adoption of scoring systems like the APACHE II system should overcome these problems. At present, the supposition that old age by itself is a bad prognostic factor in the outcome of ARF is dubious and it is certainly not strong enough to deny individual elderly patients with ARF the opportunity of aggressive therapy.     

Cardiovascular Risk Factors and Incident Acute Renal Failure in Older Adults: The Cardiovascular Health Study

Background and objectives: Although the elderly are at increased risk for acute renal failure, few prospective studies have identified risk factors for acute renal failure in the elderly.Design, setting, participants, & measurements: The associations of cardiovascular disease risk factors, subclinical cardiovascular disease, and clinical coronary heart disease with the risk for development of acute renal failure were examined in older adults in the Cardiovascular Health Study, a prospective cohort study of community-dwelling older adults. Incident hospitalized cases of acute renal failure were identified through hospital discharge International Classification of Diseases, Ninth Revision codes and confirmed through physician diagnoses of acute renal failure in discharge summaries.Results: Acute renal failure developed in 225 (3.9%) of the 5731 patients during a median follow-up period of 10.2 yr. In multivariate analyses, diabetes, current smoking, hypertension, C-reactive protein, and fibrinogen were associated with acute renal failure. Prevalent coronary heart disease was associated with incident acute renal failure, and among patients without prevalent coronary heart disease, subclinical vascular disease measures were also associated with acute renal failure: Low ankle-arm index (≤0.9), common carotid intima-media thickness, and internal carotid intima-media thickness.Conclusions: In this large, population-based, prospective cohort study, cardiovascular risk factors and both subclinical and clinical vascular disease were associated with incident acute renal failure in the elderly.Acute renal failure (ARF) occurs most commonly in older adults and is associated with significant morbidity and mortality, with death rates among hospitalized patients ranging from 25 to >70% (1–4). Despite the prevalence of ARF in elderly adults, few studies have examined potential risk factors (5–7), and no studies have examined risk factors in the elderly. The limited data from small studies suggest that cardiovascular disease (CVD) risk factors, such as hypertension, diabetes, and inflammatory markers, and clinical CVD may be associated not only with chronic kidney disease (CKD) but also ARF. These associations may be particularly important in the elderly, in whom CVD is prevalent. We hypothesized that CVD risk factors and subclinical and clinical disease would be associated prospectively with the risk for development of ARF in older adults. To address these hypotheses, we evaluated the associations of these characteristics with incident ARF in the Cardiovascular Health Study (CHS), a large cohort study of older adults. If our hypotheses are correct, then prospective identification of risk factors for ARF in the elderly may suggest potential subgroups of this high-risk population that may merit additional attention or intervention.     

Continuous venovenous haemodialysis: a study of 84 cases

Slow continuous therapies are the choice treatment in critically ill patients with acute renal failure (ARF). Over 4 years (1994-97) we retrospectively studied 84 intensive-care unit patients suffering from ARF and multiple organ failure, and treated with continuous venonenous haemodialysis (CVV-HD). The main cause of ARF was sepsis (59.3%). The global mortality was 88% and the patients who died were older than the survivors (p = 0.004). The main cause of dialyser change was the ratio FUN/BUN < or = 0.8 (61.6%); this ratio was calculated from the quotient filtrate urea nitrogen/blood urea nitrogen (urea nitrogen = urea/2.14). Most patients (94.8%) treated with initial replacement fluid infusion didn't show falls in blood pressure (BP). CONCLUSIONS: 1. The mortality was higher in elderly patients. 2. In most cases the monitoring FUN/BUN ratio allowed recovery of the patient's blood before clotting in the extracorporeal circuit. 3. The replacement fluid infusion at the beginning of the CVV-HD procedure contributes to patient's haemodynamic stability, because BP usually falls due to excessive ultrafiltration.     

Epidemiology of de novo acute renal failure in hospitalized African Americans: comparing community-acquired vs hospital-acquired disease

BACKGROUND: The high incidence and prevalence of end-stage kidney disease among African Americans is well known, but the epidemiology of acute renal failure (ARF) among African Americans is unknown. This study was designed to determine the incidence, associated risk factors, and prognosis of ARF in hospitalized African Americans and to compare these variables in hospital-acquired ARF (HA-ARF) against community-acquired ARF (CA-ARF). METHODS: A 3-year (1994-1996), computer-assisted retrospective analysis of hospital discharges with confirmed diagnoses of ARF. One hundred of 240 cases met the inclusion criteria for de novo ARF. Demographic, laboratory, and clinical profiles of all patients were retrieved and subdivided into CA-ARF and HA-ARF. Both analysis of variance and chi2 tests were used for analysis. Survival regression used both the Cox proportional hazards and Kaplan-Meier models. RESULTS: The incidence of CA-ARF was 3.5 times greater than that of HA-ARF (0.55% vs 0.15%). The mean age of all patients was 54 years with a 67% male predominance. There were no significant differences in age, sex, peak serum creatinine levels, or underlying medical history. Prerenal causes of ARF were more common among CA-ARF than HA-ARF (35% vs 19%; P = .07), but intra-renal causes were more common among HA-ARF (81% vs 55%; P = .07). All cases of obstruction occurred in CA-ARF. Mortality was higher in HA-ARF (59% vs 33%; P = .03), and the incidence of recognized predictors of mortality was higher in patients with HA-ARF than in those with CA-ARF: oliguria (59% vs 35%; P = .04); sepsis (73% vs 35%; P = .004); stay in the intensive care unit (ICU) or mechanical ventilation (55% vs 6%; P<.001); and multiorgan failure (59% vs 24%; P = .002). Those with HA-ARF were twice as likely to require dialysis as those with CA-ARF. The mortality was high in younger patients with CA-ARF and in older patients with HA-ARF, but the dialysis-related mortality rate was 3-fold higher among patients with HA-ARF. While mean +/- SD length of hospital stay was more prolonged in HA-ARF than CA-ARF (26 +/- 28 days vs 12 +/- 11 days; P<.001), the 120-day survival rate was lower in HA-ARF than CA-ARF (43% vs 66%; P = .05). The HA-ARF status was associated with a relative risk of 2.5 (confidence interval, 1.1-5.5; P = .03) for shortened survival. CONCLUSIONS: The overall epidemiologic characteristics of ARF among hospitalized African Americans seem to be comparable to those in whites, but the difference in incidence between CA-ARF and HA-ARF was much higher in African Americans. In view of the high mortality and morbidity rates associated with ARF and the fact that younger African American patients with CA-ARF were more likely to die than their older counterparts, we recommend that renal failure awareness be incorporated into community-based health educational programs in African American populations.     

老年人急性肾功能衰竭的临床特点

目的：探讨老年急性肾功能衰竭（ARF）的临床特点,方法：将151例ARF病人分为老年组（47例）和对照组（104例）,并比较两组病人的临床资料、治疗方法和预后。结果老年组引起ARF最常邮病因是感染,明显高于对照组（P＜0．01）,而肾实质性疾病引起的ARF明显低于对照组（P＜0．01）。多脏器功能衰竭的发生率、病死率均明显高于对照组（P＜0．01）。治疗开始前血清肌酐水平明显低于对照组（P＜0．01）。接受透析治疗病例数明显低于对照组P＜0．01）。结论老年ARF的原发疾病及临床经过有其特殊性。加强透析治疗,尤其早期预防透析是治疗成功的关键,预后与年龄、原发病能否控制及透析时机的选择有关。     

Acute renal failure in the elderly treated by one-time peritoneal dialysis

To determine the factors affecting outcome of acute renal failure (ARF) in the elderly, we retrospectively studied 44 patients over the age of 65 who had undergone acute peritoneal dialysis. Thirteen patients (29%) survived 2 months or longer after dialysis treatment ("survivors"). Thirty-one patients (71%) died within this period ("nonsurvivors"). The main factor distinguishing survivors was the frequency of sepsis (none of 13 survivors vs 17 of 31 nonsurvivors). Preexisting malignancy and total number of acute insults to renal function were significantly less frequent, and immediate clinical and biochemical outcome of dialysis significantly better in survivors. The overall complication rate of dialysis was high (31 of 44 patients), but was significantly lower in survivors. Acute peritoneal dialysis is a useful procedure in the management of ARF in the elderly. However, we suggest that elderly patients in whom sepsis is a contributory factor to the development of ARF do not benefit from peritoneal dialysis therapy.     

老年肾病综合征并发急性肾功能衰竭21例临床分析

目的　深入探讨老年肾病综合征 (NS)并发急性肾功能衰竭 (ARF)的临床、病理及预后。　 方法　对 2 1例老年及 3 8例非老年NS并发ARF患者的病因、临床特征、病理特点以及预后等进行回顾性分析。　 结果　老年组NS并发ARF发病率为 2 4 7% ;非老年组为 7 3 %。老年组与非老年组比较有以下特点 :(1)老年NS并发ARF发病率高 ,男性多见 (71 4% ) ,病死率高 ,治愈率低 ;(2 )蛋白尿程度极重、血浆蛋白极低 ;(3 )病理以膜性肾病、局灶节段性肾小球硬化多见 ;(4 )病因以原发性肾小球疾病、糖尿病肾病为主。　 结论 　老年NS并发ARF发病率高 ,病理以膜性肾病、局灶节段性肾小球硬化为主 ,蛋白尿及低蛋白血症严重 ,预后差。