Nonoliguric Acute Renal Failure

Anderson, Robert J.; Linas, Stuart L.; Berns, Arnold S.; Henrich, William L.; Miller, Thomas R.; Gabow, Patricia A.; Schrier, Robert W.

doi:10.1056/nejm197705192962002

Cited by 363 publications

(99 citation statements)

References 15 publications

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“…The mortality rate of non-oliguric ARF was found to be lower than that of oliguric ARF (33)(34). There were, however, no significant differences in the clinical characteristics, the severity of renal failure, and the mortality rate between spontaneously non-oliguric patients and patients becoming non-oliguric after furosemide (33)(34).…”

Section: Diureticsmentioning

confidence: 83%

Prevention and Treatment of Acute Renal Failure in Sepsis

Vriese

2003

Journal of the American Society of Nephrology

111

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Section: Diureticsmentioning

confidence: 83%

Prevention and Treatment of Acute Renal Failure in Sepsis

Vriese

2003

Journal of the American Society of Nephrology

111

View full text Add to dashboard Cite

“…> 160 μmοΙ/L). Patients with normal urine output and increasing blood urea and serum creatinine were defined as having non-oliguric renal failure and included in this study [5].…”

Section: Methodsmentioning

confidence: 99%

“…> 160 μmοΙ/L). Patients with normal urine output and increasing blood urea and serum creatinine were defined as having non-oliguric renal failure and included in this study [5].Pre-renal failure was diagnosed if the urine osmolality was more than 500 mosmol/L, urine urea to plasma urea concentration ratio more than five, fractional excretion of sodium "FeNa" less than 1% [6]. In cases we doubted a fluid challenge of 20 ml/kg of dextrose saline was given in order to differentiate between pre-renal and intrinsic renal failure.…”

mentioning

confidence: 99%

Etiology, Presentation and Mangement of Acute Renal Failure in Saudi Children

et al. 1992

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One hundred children with acute renal failure (ARF) were admitted in our Nephrology Unit, Maternity & Children's Hospital over a four year period. Male patients outnumbered females with a ratio of 3:2. The ages of patients ranged from 1 month to 13 years with a mean age of 3.9 years. Fifty-five were suffering from intrinsic renal factors, 32 from post-renal and 13 were due to pre-renal factors. Among the intrinsic renal causes: acute glomerulonephritis (27 patients) and hemolytic-uremic syndrome (15 patients) were most common. Posterior urethral valve (20 patients) was the leading cause of post-renal failure. All pre-renal failure was due to diarrheal disease. Forty patients with ARF required dialysis (23 peritoneal dialysis, 17 hemodialysis). The remaining 60 patients were treated conservatively. The outcome in our patients were as follows: 60% cured, 29% continued to have variable degrees of renal failure and only 11% died. The latter was due to sepsis and cardiorespiratory failure. Acute renal failure (ARF) is not uncommon in children. The incidence varies from 4-22 per million population [1]. Intrinsic renal failure is the leading cause of ARF in developed countries [2], whereas pre-renal failure due to renal hypoperfusion is the leading cause of ARF in developing countries [3]. Post-renal failure occurs usually due to obstructive uropathy reported in 2% to 15% of children with ARF [4].No data are available from the Kingdom of Saudi Arabia regarding children presenting with ARF. We conducted this study in order to analyze the etiological factors, clinical presentation, response to the different modes of treatment and the outcome in 100 children admitted to our renal unit with this condition. Methods and MaterialsThe study included 100 children with ARF referred to our unit from different parts of the Kingdom over a period of four years. Children less than one-month-old were excluded from the study as the pattern of disease is different at this age.Acute renal failure was defined as a reduction in glomerular filtration rate "GFR" as manifested by oliguria (urine volume less than 300 ml/M2/day) or anuria (urine volume less than 1 ml/kg/day) and niore than 50% decrease in renal function as measured by serum creatinine (i.e. > 160 μmοΙ/L). Patients with normal urine output and increasing blood urea and serum creatinine were defined as having non-oliguric renal failure and included in this study [5].Pre-renal failure was diagnosed if the urine osmolality was more than 500 mosmol/L, urine urea to plasma urea concentration ratio more than five, fractional excretion of sodium "FeNa" less than 1% [6]. In cases we doubted a fluid challenge of 20 ml/kg of dextrose saline was given in order to differentiate between pre-renal and intrinsic renal failure. Initial diagnosis of post-renal failure was made by renal ultrasonography which was done routinely on all cases. Other investigations done at different stages of illness include renal isotope scan, micturating cystogram and transurethral endoscopy. Renal biopsy was done ...

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“…Patients with AKI who develop reduced urine output have substantially greater risk of death (13)(14)(15)(16), longer duration of dialysis dependence (16), and longer hospital stay (13) compared with those who do not. Reduced urine output in patients with AKI requiring RRT may indicate a greater severity of kidney injury with less likelihood of renal recovery (17), greater associated mortality (14), and predisposition to complications related to volume management (18,19).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Urine Output among Patients Treated with More Intensive Versus Less Intensive RRT: Results from the Acute Renal Failure Trial Network Study

Causland

Asafu‐Adjei

Betensky

et al. 2016

CJASN

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Background and objectives Intensive RRT may have adverse effects that account for the absence of benefit observed in randomized trials of more intensive versus less intensive RRT. We wished to determine the association of more intensive RRT with changes in urine output as a marker of worsening residual renal function in critically ill patients with severe AKI.Design, setting, participants, & measurements The Acute Renal Failure Trial Network Study (n=1124) was a multicenter trial that randomized critically ill patients requiring initiation of RRT to more intensive (hemodialysis or sustained low-efficiency dialysis six times per week or continuous venovenous hemodiafiltration at 35 ml/kg per hour) versus less intensive (hemodialysis or sustained low-efficiency dialysis three times per week or continuous venovenous hemodiafiltration at 20 ml/kg per hour) RRT. Mixed linear regression models were fit to estimate the association of RRT intensity with change in daily urine output in survivors through day 7 (n=871); Cox regression models were fit to determine the association of RRT intensity with time to $50% decline in urine output in all patients through day 28.Results Mean age of participants was 60615 years old, 72% were men, and 30% were diabetic. In unadjusted models, among patients who survived $7 days, mean urine output was, on average, 31.7 ml/d higher (95% confidence interval, 8.2 to 55.2 ml/d) for the less intensive group compared with the more intensive group (P50.01). More intensive RRT was associated with 29% greater unadjusted risk of decline in urine output of $50% (hazard ratio, 1.29; 95% confidence interval, 1.10 to 1.51).Conclusions More intensive versus less intensive RRT is associated with a greater reduction in urine output during the first 7 days of therapy and a greater risk of developing a decline in urine output of $50% in critically ill patients with severe AKI.

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Nonoliguric Acute Renal Failure

Cited by 363 publications

References 15 publications

Prevention and Treatment of Acute Renal Failure in Sepsis

Prevention and Treatment of Acute Renal Failure in Sepsis

Etiology, Presentation and Mangement of Acute Renal Failure in Saudi Children

Comparison of Urine Output among Patients Treated with More Intensive Versus Less Intensive RRT: Results from the Acute Renal Failure Trial Network Study

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