It has been suggested that salt loading protects against amphotericin B-induced nephrotoxicity. The influence of saline loading on the nephrotoxic response to amphotericin B (50 mg/dose given i.v. over 4 hr 3 X/week for 10 weeks) was assessed in two groups of ten patients each who were diagnosed with mucocutaneous leishmaniasis. Patients were randomized to receive either 1 liter of 0.9% saline or 1 liter of 5% dextrose in water, administered i.v. over one hour in a double-blinded manner, directly prior to amphotericin B administration. Renal function was monitored on a weekly basis two days after the last dose of amphotericin B. Baseline characteristics were similar in both groups except for a slightly higher serum creatinine concentration (Cr) in the saline group (0.8 +/- 0.05 vs. 0.6 +/- 0.04 mg/dl). Baseline sodium (Na) excretion was relatively high (262 +/- 23 mmol/day in the dextrose group and 224 +/- 17 mmol/day in the saline group). None of the patients sustained an increase in Cr to values greater than 1.7 mg/dl. Although mean Cr remained within normal, there was a significant difference between the two groups over the ten week period, with the dextrose group sustaining a significant increase in Cr and the saline group remaining unchanged. Serum potassium (K) levels fell in both groups necessitating oral K supplementation. The saline group required significantly greater amounts of K supplementation to maintain a normal serum K. Amphotericin B caused a rapid reduction in the acidification ability of the kidney in response to an ammonium chloride load. Under these conditions, the saline group had a poorer ability to acidify the urine.(ABSTRACT TRUNCATED AT 250 WORDS)

Oliguria, age, and sepsis are factors associated with mortality in children with ARF.

The salivary urea test has a great capacity to discriminate patients with chronic kidney disease from healthy people, and it was shown that the best cutoff point is 40 mg/dL.

Introduction: Although experience within Peru suggests clinical and physiological benefits of treating dehydration caused by diarrhoea with Lactated Ringer's solution (LR) over sodium chloride 0.9%, (NaCl) there is little documented scientific evidence supporting this view. It is important to clarify this issue and determine the best solution for use during epidemics. Methodology: Forty patients suffering from dehydration due to choleriform diarrhoea were enrolled in the study. Twenty patients were treated using NaCl (Group A) and the other twenty with LR (Group B). After diuresis recovery was achieved, the patients were continued on a course of oral rehydration salts. Serum electrolytes, arterial pH, HCO 3

SUMMARYIn order to find the incidence rate of acute renal failure (ARF) in cholera dehydrated patients we studied at the Hospital Nacional Cayetano Heredia of Lima-Perú, 19, 286 patients, who were attended for rehydration, between February 1, 1991 and March 31, 1992. In those patients we determined the most probably causes that were associated with mortality when ARF was present. We found that the incidence rate of ARF was 10.6/1000. Mortality in these patients were 18%. Age was the most important variable in the risk of developing ARF in cholera. Non oliguric ARF was more frequent in the first period of the epidemia (p<0.05). The hospitalization average was 11.21+ 7.23 days and the permanence in the hospital was associated with the requirement of dialysis. The rate of patients who died with cardiorespiratory involvement was 40%, agains 6,9% when it was not present (p<0.001). The rate of patients who died with systemic infection was 77% against 15% when it was not present (p<0.001). Azotemia was related with neurologic involvement but it was not with risk of death. (Rev Med Hered 1992; 3:140-147).KEY WORDS: Cholera, acute renal failure, epidemiology RESUMEN Con la finalidad de precisar la incidencia de insuficiencia renal aguda (IRA) en pacientes deshidratados por cólera en el Hospital Nacional Cayetano Heredia de Lima, Perú, se evaluó a 19,286 pacientes atendidos por deshidratación por cólera entre el 1º de febrero de 1991 y el 31 de marzo de 1992. En ellos se ha determinado los factores que influencian y las causas más probables que se asocian a la mortalidad cuando la IRA se presenta. Se encontró que la incidencia de IRA fue de 10.6 por mil y la mortalidad en IRA de 18%. La mayor edad fue el principal factor para el riesgo de desarrollar IRA por cólera. La forma IRA no oligúrica mostró una mayor frecuencia en el periodo inicial de la epidemia (p<0.05). El promedio de hospitalización fue 11.21 + 7.23 días y la mayor estancia hospitalaria se relacionó a mayor necesidad de diálisis. El 40% de pacientes con compromiso cardiorrespiratorio fallecieron, contra solo el 6.9% de fallecidos entre pacientes sin compromiso cardiorrespiratorio (p<0.001). De igual manera el 77% de

Se evaluó la letalidad y el riesgo de insuficiencia renal en pacientes con enfermedad diarreica coleriforme en el Hospital Nacional Cayetano Heredia, tratados con un esquema de rehidratación utilizando cloruro de sodio al 0.9% endovenoso y sales de rehidratación oral. El estudio se realizó durante la epidemia de cólera entre los meses de febrero y mayo de 1991, en que se atendieron a 8675 pacientes, de los cuales 4500 fueron hospitalizados por deshidratación moderada o severa. Las tasas de letalidad y de insuficiencia renal aguda (IRA) en el mes de febrero, antes de aplicar el esquema de rehidratación, fueron 1.77 y 30.14x1000 respectivamente. Durante la aplicación del esquema en los meses de marzo, abril y mayo las tasas de letalidad y de IRA fueron 0.64, 0.58 Y 0.0x1000 y de 577 y 3.00x100 respectivamente.

Treatment with amphotericin B deoxycholate (AB) is associated with dose-related nephrotoxicity. We conducted an open and randomized trial to evaluate the efficacy of an oral rehydration solution (ORS) to prevent nephrotoxicity of AB, compared with an intravenous saline solution (SS). Adult patients with mucosal leishmaniasis in whom AB was indicated received either three liters or ORS or one liter of SS. Renal function tests were performed at baseline and during treatment. Forty-eight patients were included (ORS = 25, SS = 23). No difference was observed in serum creatinine, creatinine clearance, serum urea, and serum sodium values during treatment, but serum potassium values were lower in the SS group than in the ORS group (P < 0.03). Treatment was more temporarily discontinued in the SS group than in the ORS group (7 patients versus 1 patient, P = 0.02). We conclude that ORS is comparable to SS in preventing glomerular damage of AB, but more effective in preventing hypokalemia.

Objetivos: Identificar factores asociados a la injuria renal aguda (IRA) en pacientes que acudieron a emergencia de un hospital general. Material y métodos: Estudio caso-control, se incluyeron 50 casos y 100 controles de pacientes incidentes a emergencia de un hospital III-B de Lima. Se analizó los datos mediante OR. Resultados: Los factores de riesgo encontrados fueron la condición de gravedad del paciente (OR=6,14), la presencia de un cuadro infeccioso como diagnóstico al ingreso, la existencia de sepsis y el estar en shock séptico (OR=2,85; 3,78 y 6,77 respectivamente). Las comorbilidades asociadas a la incidencia de IRA de la comunidad fueron: enfermedad respiratoria, alcohol y tabaco, neoplasia maligna y enfermedad neuropsiquiátrica (p=0,001). La edad, sexo y otras variables de filiación y situación socioeconómica no estuvieron relacionados. Conclusiones: Los factores asociados a IRA fueron la presencia de un cuadro infeccioso, su gravedad y la presencia de comorbilidades preexistentes.