Fernando Liao Julio Pascual

There are many causes—more than fifty are given within this present chapter—that can trigger pathophysiological mechanisms leading to acute renal failure (ARF). This syndrome is characterized by a sudden decrease in kidney function, with a consequence of loss of the hemostatic equilibrium of the internal medium. The primary marker is an increase in the concentration of the nitrogenous components of blood. A second marker, oliguria, is seen in 50% to 70% of cases.

In general, the causes of ARF have a dynamic behavior as they change as a function of the economical and medical development of the community. Economic differences justify the different spectrum in the causes of ARF in developed and developing countries. The setting where ARF appears (community versus hospital), or the place where ARF is treated (intensive care units [ICU] versus other hospital areas) also show differences in the causes of ARF.

While functional outcome after ARF is usually good among the surviving patients, mortality rate is high: around 45% in general series and close to 70% in ICU series. Although it is unfortunate that these mortality rates have remained fairly constant over the past decades, it should be noted that today's patients are generally much older and display a generally much more severe condition than was true in the past. These age and severity factors, together with the more aggressive therapeutical possibilities presently available, could account for this apparent paradox.

As is true for any severe clinical condition, a prognostic estimation of ARF is of great utility for both the patients and their families, the medical specialists (for analysis of therapeutical maneuvers and options), and for society in general (demonstrating the monetary costs of treatment). This chapter also contains a brief review of the prognostic tools available for application to ARF.

0 0

Post a comment