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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Over a period of 2 years, 82 patients out of 2,390 (3.43%) admitted to an intensive care unit developed acute renal failure (ARF). The diagnosis of ARF was based on the usual criteria of oliguria, a rising blood urea nitrogen and creatinine, urine sodium concentration greater than 20 mmol/l and a U/P osmolality ratio less than 1.1. In 9.2% of patients the latter two criteria were misleading. Sepsis was the commonest cause of vasomotor nephropathy but in 20.7% potentially nephrotoxic agents had been administered before development of ARF. Overall mortality was 73.2%, with patients older than 50 years of age having the highest mortality. ARF is associated with prolonged bed occupancy--an average of 59.8 days for the dialysed patients with ARF versus an average length of stay of 8.4 days for the hospital overall.
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PMID:Aetiology, diagnosis, treatment and prognosis of acute renal failure in an intensive care unit. 54 32

The association of nephrotic syndrome and renal vein thrombosis has been increasingly reported in the literature due to the use of modern complementary explorative techniques. The incidence of renal vein thrombosis in the nephrotic syndrome varies according to the different authors. The pathogenesis of this association has been widely discussed and even though renal vein thrombosis has formerly been considered as one more cause of nephrotic syndrome, there are at present numerous arguments supporting the opposite thesis. A case of nephrotic syndrome and unilateral thrombosis of the renal vein in a patient with primitive extramembranous glomerulonephritis is reported. Blood coagulation studies revealed an initial hyperfibrinogenemia and a persistent decrease of factors V, VII, and X, with low rates of prothrombin. A thrombectomy was carried out, but the patient presented a Gram-negative sepsis without hypotension in the immediate postoperative period. As a consequence an acute renal failure developed and hemodyalisis was necessary for 2 months. The pathogenesis of both conditions are discussed.
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PMID:[Nephrotic syndrome and unilateral thrombosis of the renal vein. Acute renal failure and disturbances of the hemostasis (author's transl)]. 54 30

Oliguria, an easily recognizable symptom of postoperative acute renal failure, is analyzed schematically in terms of various diagnostic aspects and a pragmatic therapeutic procedure. Differentiation among pre-, intra-, and postrenal disturbances is important. Acute renal failure caused by simultaneous and often severe insufficiency of other organs, especially in combination with septicemia, still has a bad prognosis. Prophylaxis in the form of adequate volume substitution and shock therapy is urgent in each case.
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PMID:[Renal complications after general surgical operations (author's transl)]. 59 18

Acute renal failure may be a contributory cause of death in patients with acute leukemia. The purpose of this study was to define the causes and course of acute renal failure in group of patients with acute leukemia in order to identify preventive measures and reversible aspects of the renal insufficiency. Among 88 patients with acute leukemia whose courses were followed to the time of death, ten developed acute renal failure. Etiologic factors of the renal failure were uric acid nephropathy, sepsis with complicating hypotension and hypovolemia, and the administration of nephrotoxic antibiotics. In one patient ureteral obstruction from clots was responsible for renal failure, while in another patient disseminated aspergillosis led to renal failure. Other causes of acute renal failure in persons with acute leukemia, but not observed in this patient group, are hypercalcemia and leukemic infiltration of the kidneys.
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PMID:Acute renal failure in patients with acute leukemia. 63 12

The clinical course and follow-up of 14 neonates who developed acute renal failure are reported. Renal failure in these patients was secondary to major perinatal disorders, e.g., hyaline membrane disease, pneumonia, hemorrhage, or sepsis. Thirteen patients had hypoxia and nine were in shock when renal failure developed. Five patients died during the acute stage of renal failure. Of nine survivors, five patients sustained residual renal damage.
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PMID:Acute renal failure in newborn infants. 66 Mar 74

The mortality among 604 patients with pelvic fractures was 12%. Pedestrian accidents were the etiologic agent in 27% of the patients, but accounted for 49% of the deaths and for 73% of the deaths primarily due to pelvic fractures. Although 71 of the 72 patients who died sustained concomitant major injuries (mean, 3.1), 60% of the deaths (43 patients) were attributed entirely or in part to pelvic fractures. Of particular interest were the 26 patients in whom the pelvic fracture was the primary cause of death. Ninety-three percent were in shock or had clinical evidence of hypovolemia at the time of admission. Eighteen patients (69%) exsanguinated from their pelvic fractures shortly after hospital admission (mean, 9 hours). They were more elderly than the eight patients who survived their initial resuscitation, but subsequently died of sepsis or of renal failure (mean, 62 vs. 38 years). Sepsis arising in the pelvic hematoma and acute renal failure induced by pelvic hemorrhage and/or pelvic sepsis each accounted for 15% of the deaths. Ninety-one percent of the patients who died primarily of their pelvic fracture had a single or double break in the pelvic ring. Thirty-one precent had open pelvic fractures, and injury associated with a 50% mortality. Twenty-three percent had pelvic fracture related iliac or femoral vessel disruptions, an injury associated with a 75% mortality. Mortality in these patients clearly resulted from ineffective control of pelvic hemorrhage and from the inability to prevent sepsis in the pelvic hematoma.
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PMID:The mortality associated with pelvic fractures. 68 27

A study was performed in order to observe haemodynamic changes induced by haemodialysis in 14 patients with acute renal failure and severe sepsis. Left ventricular function, as assessed by changes in pulmonary wedge pressure and left ventricular stroke work index through plasma volume expansion, did not change during haemodialysis. Ultrafiltration-induced decreases in cardiac index provoked in 8 patients, with nearly normal initial systemic arteriolar resistance, had adequate and constant increase in their resistance (p less than 0.001), whereas 6 patients with low initial systemic arteriolar resistance did not increase their resistance and had a frequent (9/13 measurements) and significant (p less than 0.001) fall in mean aortic pressure. This abnormality of vascular tone is probably due to severe sepsis and explains why hypotension is a frequent occurrence during haemodialysis in such patients.
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PMID:Haemodynamic study of patients with severe sepsis during haemodialysis. 69 Mar 21

Acute pancreatitis is discussed from the viewpoint of a medical intensive care unit, with particular reference to the early and late complications. The measures which must be promptly implemented in order to successfully combat the grave early complications of shock and acute renal failure are stressed. Continuous monitoring ensures that prompt surgical management is undertaken in cases of late complications-abscess formation, sequestration and sepsis. A review of the characteristic clinical and laboratory data of patients with acute pancreatitis treated in our unit is presented in table I.
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PMID:[Acute pancreatitis with shock and acute renal failure (author's transl)]. 80 78

Bone marrow toxicity occurred in 4 of 15 patients treated with 5-fluorocytosine (5-FC) for serious fungal infections. The development of marrow toxicity appeared to be related to serum 5-FC levels of 125 mug/ml or greater. In three patients, accumulation of toxic levels of 5-FC was related to diminished renal function. One patient with acute renal failure and prolonged high levels of 5-FC developed marrow aplasia and died of bacterial sepsis. Three patients experienced leukopenia, which was readily reversed when the dosage of 5-FC was decreased and the serum concentration was lowered. With careful monitoring of serum 5-FC concentration and renal function, the dose-related toxic effects of 5-FC on the marrow can be avoided.
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PMID:Bone marrow toxicity associated with 5-fluorocytosine therapy. 84 28

A 3-year experience with 50 acute renal failure patients managed by hemodialysis in a 417-bed community hospital is reviewed. The 58% survival rate was better than that reported in other recent series. Possible reasons for our favorable mortality experience include: (1) Hemodialysis was performed within the ICU facility by the ICU staff. Continuity of total care was thereby maintained and hemodialysis problems, such as maintenance of circulating volume, were managed in the context of continued assessment of the patient's cardiopulmonary status. (2) In contrast to previous reports, the presence of sepsis did not influence recovery rates from acute renal failure. Early administration of specific antibiotics, mainly gentamicin, rapid drainage of abdominal abscesses, and early and frequent dialysis were all utilized in spetic patients and may have contributed to their high recovery rate. (3) The use of agressive dialysis may also have lessened other uremic complications, notably gastrointestinal bleeding. Our dialysis organization and procedures are described.
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PMID:Acute renal failure. Community hospital experience with hemodialysis as intensive care adjunct. 86 9


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