Acute renal failure of medical type in an elderly population
Acute renal failure of medical type in an elderly population
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DOI：
10.1093/ndt/13.suppl_7.25
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发表时间：
1998-01-01
影响因子：
6.1
通讯作者：
Lusvarghi, E
中科院分区：
文献类型：
--
作者：
Baraldi, A;Ballestri, M;Lusvarghi, E
109例内科病因学未选定的急性肾功能衰竭患者在波利奇尼科大学医院(摩德纳)的肾脏科住院，为期30个月。在慢性肾功能衰竭中，ARF被认为是血肌酐迅速升高，超过基线水平2 mg/dl或者是原有水平的两倍。患者平均年龄67+/-17岁，中位年龄72岁，64.2%需要透析治疗。ARF的四个主要原因被确定：33例患者因脱水、低血压等原因导致肾血流灌注减少；20例多因素病因；14例肾活检调查的肾实质疾病；39例药物相关性急性肾功能衰竭(D-ARF)。老年患者的临床结果在死亡率(P<；0.02)、慢性透析治疗(P<；0.04)和完全恢复(P<；0.004)方面明显更差。DARF患者的平均年龄显著大于其余ARF患者(72.6vs63.2vs63.2vs18.5vs72.612.8vs63.2vs18.5：P<；0.004)。非甾体抗炎药(NSAIDs)和血管紧张素转换酶抑制剂(Ace-I)分别导致24例和8例ARF。高龄、血管疾病和单克隆性丙种球蛋白病是主要的危险因素，在D-ARF患者中发生率明显更高(分别为P<；001、P<；0.01、P<；0.04)。我们的数据证实了老化肾脏对药物通过微血管机制影响肾小球自身调节所引起的肾毒性损害的高度敏感性。更多地关注肾脏在衰老过程中的变化，并在肾病学家中更多地传播预防措施，可以减少这些严重和潜在致命疾病的发生率。
One hundred and nine unselected patients with Acute Renal Failure (ARF) of medical aetiology were hospitalized at the Nephrological Unit of Policlinico University Hospital (Modena) during a 30-month period. ARF was considered as a rapid increase of serum creatinine > 2mg/dl over the baseline level or the doubling of pre-existing value in chronic renal failure. Mean age of patients was 67+/-17 years and median age was 72; 64.2% needing dialytic treatment. Four main causes of ARF were identified: 33 patients had reduced renal perfusion by dehydration, hypotension etc.; 20 multifactorial aetiology; 14 biopsy-investigated renal parenchymal diseases and 39 had drug-related acute renal failure (D-ARF). The clinical outcome was significantly worse in elderly patients as regard mortality (P < 0.02), chronic dialytic treatment (P < 0.04) and complete recovery (P < 0.004). The mean age of D-ARF patients was significantly greater than remaining ARF patients (72.6+/-12.8 vs 63.2+/-18.5: P < 0.004. Nonsteroidal antiinflammatory drugs (NSAIDs) and ACE-inhibitors (Ace-i) caused ARF in 24 and 8 patients respectively. Elderly age, vascular disease and monoclonal gammopathy represented the main risk factors and were significantly more frequent in D-ARF patients (P < 001, < 0.01, < 0.04 respectively). Our data confirm the high susceptibility of ageing kidneys to nephrotoxic damage caused by drugs affecting glomerular autoregulation by microvascular mechanisms. Greater attention to renal changes in ageing and an increased dissemination of preventative measures among nephrologists, could reduce the incidence of these serious and potentially lethal diseases.