Figure 815

Historical perspective of acute renal failure (ARF) patterns in France, India, and South Africa. In the 1960s and 1970s, obstetrical causes were a great problem in both France and India and overall incidences of ARF were similar. Surgical cases were almost negligible in India at that time, probably because of the relative unavailability of hospital facilities. During the 1980s surgical and medical causes were similar in both countries. In India, the increase in surgical cases may be explained by advances in health care, so that more surgical procedures could be done. The decrease in surgical cases in France, despite the fact that surgery had become very sophisticated, could be explained by better management of surgical patients.

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FIGURE 8-15 (Continued)

Changes in classification criteria—inclusion of a larger percentage of medical cases than a decade before—could be an alternative explanation. In addition, obstetric cases had almost disappeared in France in the 1980s, but they were still an important cause of ARF in India. In a South African study that excluded the white population the distribution of ARF causes was almost identical to that observed in India 20 years earlier. In conclusion, 1) the economic level of a country determines the spectrum of ARF causes observed;

2) when a developing country improves its economic situation, the spectrum moves toward that observed in developed countries; and

3) great differences can be detected in ARF causes among developing countries, depending on their individual economic power. (Data from Kleinknecht [13]; Chugh et ail. [14]; Seedat et al. [15].)

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