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VOLUME 14 , ISSUE 3 ( July, 2010 ) > List of Articles

RESEARCH ARTICLE

Acute kidney injury after trauma: Prevalence, clinical characteristics and RIFLE classification

Krasnalhia Lívia de Abreu, Geraldo Jínior, Adller Barreto, Fernanda Melo, Bárbara Oliveira, Rosa Mota, Natália Rocha, Sônia Silva, Sônia Araújo, Elizabeth Daher

Keywords : Acute kidney injury, mortality, outcome, risk factors, trauma

Citation Information : de Abreu KL, Jínior G, Barreto A, Melo F, Oliveira B, Mota R, Rocha N, Silva S, Araújo S, Daher E. Acute kidney injury after trauma: Prevalence, clinical characteristics and RIFLE classification. Indian J Crit Care Med 2010; 14 (3):121-128.

DOI: 10.4103/0972-5229.74170

License: CC BY-ND 3.0

Published Online: 00-07-2010

Copyright Statement:  Copyright © 2010; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Acute kidney injury (AKI) is an uncommon but serious complication after trauma. The objective of this study was to evaluate the prevalence, clinical characteristics and outcome of AKI after trauma. Patients and Methods: This was a retrospective study performed from January 2006 to January 2008 in an emergency specialized hospital in Fortaleza city, northeast of Brazil. All patients with AKI admitted in the study period were included. Prevalence of AKI, clinical characteristics and outcome were investigated. Results: Of the 129 patients admitted to the intensive care unit (ICU), 52 had AKI. The mean age was 30.1 ± 19.2 years, and 79.8% were males. The main causes of AKI were sepsis in 27 cases (52%) and hypotension in 18 (34%). Oliguria was observed in 33 cases (63%). Dialysis was required for 19 patients (36.5%). Independent risk factors associated with AKI were abdominal trauma [odds ratio (OR) = 3.66, P = 0.027] and use of furosemide (OR = 4.10, P = 0.026). Patients were classified according to RIFLE criteria as Risk in 12 cases (23%), Injury in 13 (25%), Failure in 24 (46%), Loss in 1 (2%) and End-stage in 2 (4%). Overall in-hospital mortality was 95.3%. The main cause of death was sepsis (24%). Mortality was 100% among patients with AKI. Conclusions: AKI is a fatal complication after trauma, which presented with a high mortality in the studied population. A better comprehension of factors associated with death in trauma-associated AKI is important, and more effective measures of prevention and treatment of AKI in this population are urgently needed.


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  1. Kellum JA. Acute Kidney Injury. Crit Care Med 2008;36:141-5.
  2. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005;294:813-8.
  3. Liaρo F, Pascual J. Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int 1996;50:811-8.
  4. Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ. Acute renal failure in intensive care units–causes, outcome, and prognostic factors of hospital mortality; a prospective, multicenter study. French Study Group on Acute Renal Failure. Crit Care Med 1996;24:192-8.
  5. Morris JA, Mucha P, Ross SE, Moore BF, Hoyt DB, Gentilello L, et al. Acute posttraumatic renal failure: a multicenter perspective. J Trauma 1991;31:1584-90.
  6. Regel G, Lobenhoffer R Grotz M, Pape HC, Lahmann, Tscherne H. Treatment results of patients with multiple trauma: an analysis of 3406 cases treated between 1972 and 1991 at German level I trauma center. J Trauma 1995;38:70-7.
  7. Nadvi SS, Mokoena T, Gouws E, Haffajee AA. Prognosis in post-traumatic acute renal failure is adversely influenced by hypotension and hyperkalemia. Eur J Surg 1996;162:121-4.
  8. Mehta RL, Pascual MT, Soroko S, Chertow GM, PICARD Study Group. Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA 2002;288:2547-53.
  9. Ympa YP, Sakr Y, Reinhart K, Vincent J. Has mortality from acute renal failure decreased? A systematic review of the literature. Am J Med 2005;118:827-32.
  10. Menashe PI, Ross SA, Gottlieb JE. Acquired renal insufficiency in critically ill patients. Crit Care Med 1988;16:1106-9.
  11. Stene JK. Renal failure in trauma patients. Crit Care Clin 1990;6:111.
  12. Letteri JM. Post-traumatic acute renal failure. Adv Exp Med Biol 1987;212:211-8.
  13. Thadani R, Pascual M, Bonventre JV. Acute renal failure. N Engl J Med 1996;30:1448-59.
  14. Mason JC, Joeris B, Welsch J, Kriz W. Vascular congestion in ischemic renal failure: the role of cell swelling. Miner Electrolyte Metab 1989;15:114-24.
  15. Vetterlein F, Petho A, Schmidt G. Distribution of capillary blood flow in the rat kidney during postischemic renal failure. Am J Physiol 1986;215:510-9.
  16. Levy EM, Viscoli CM, Horwitz RI. The effect of acute renal failure on mortality - a cohort analysis. JAMA 1996;275:1489-94.
  17. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference, Definitions for sepsis and organ failure and guidelines for the need of innovative therapies in sepsis. Crit Care Med 1992;20:864-74.
  18. Kellum JA, Bellomo R, Ronco C. Classification of acute kidney injury using RIFLE: what′s the purpose? Crit Care Med 2007;35:983-4.
  19. Mehta RL, Pascual MT, Gruta CG, Zhuang S, Chertow GM. Refining predictive models in critically ill patients with acute renal failure. J Am Soc Nephrol 2002;13:1350-7.
  20. Silva Jr. GB, Daher EF, Mota RMS, Menezes FA. Risk factors for death among critically ill patients with acute renal failure. Sγo Paulo Med J 2006;124:257-63.
  21. Cury F, Baitello AL, Echeverria RF, Espada PC, Godoy JM. Rates of thoracic trauma and mortality due to accidents in Brazil. Ann Thorac Med 2009;4:25-6.
  22. Uchino S, Doig GS, Bellomo R, Morimatsu H, Morgera S, Schetz M, et al. Diuretics and mortality in acute renal failure. Crit Care Med 2004;32:1669-77.
  23. Brown CV, Dubose JJ, Hadjizacharia P, Yanar H, Salim A, Inaba K, et al. Natural History and Outcomes of Renal Failure after Trauma. J Am Coll Surg 2008;206:426-31.
  24. Gettings LG, Reynolds HN, Scalea T. Outcome in posttraumatic acute renal failure when continuous renal replacement is applied early vs. late. Intensive Care Med 1999;25:805-13.
  25. Vivino G, Antonelli M, Moro ML, Cottini F, Conti G, Bufi M, et al. Risk factors for acute renal failure in trauma patients. Intensive Care Med 1998;24:808-14.
  26. Guly UM, Turney JH. Post-traumatic renal failure, 1956-1988. Clin Nephrol 1990;34:79-83.
  27. Rasmussen H, Ibels L. Acute renal failure: multivariate analysis of causes and risk factors. Am J Med 1982;73:211-8.
  28. Kuiper JW, Groeneveld J, Slutsky AS, Plotz FB. Mechanical ventilation and acute renal failure. Crit Care Med 2005;33:1408-15.
  29. Brown CV, Rhee P, Evans K, Demetriades D, Velmahos G. Rhabdomyolysis after penetrating trauma. Am Surg 2004;70:890-2.
  30. Honda N. Acute renal failure and rhabdomyolysis. Kidney Int 1983;23:888-98.
  31. Ward MM. Factors predictive of acute renal failure in rhabdomyolysis. Arch Intern Med 1988;148:1553-7.
  32. Shustermann N, Strom BL, Murray TG. The risk factors and outcome of hospital-acquired acute renal failure. Am J Med 1987;83:63-71.
  33. Hou SL, Bushinsky DA, Wish DB, Cohen JJ, Harrington JT. Hospital-acquired renal insufficiency: a prospective study. Am J Med 1983;74:243-8.
  34. Bosch X, Poch Esteban, Grau JM. Rhabdomyolysis and Acute Kidney Injury. N Engl J Med 2009;361:62-72.
  35. Holt SG, Moore KP. Pathogenesis and treatment of renal dysfunction in rhabdomyolysis. Intensive Care Med 2001;27:803-11.
  36. de Meijer AR, Fikkers BG, de Keijzer MH, van Engelen BG, Drenth JP. Serum creatine kinase as predictor of clinical course in rhabdomyolysis: a 5-year intensive care survey. Intensive Care Med 2003;29:1121-5.
  37. Woodrow G, Brownjohn AM, Turney JH. The clinical and biochemical features of acute renal failure due to rhabdomyolysis. Ren Fail 1995;17:467-74.
  38. Giannoglou GD, Chatzizisis YS, Misirli G. The syndrome of rhabdomyolysis: pathophysiology and diagnosis. Eur J Intern Med 2007;18:90-100.
  39. Wrogemann K, Pena SD. Mitochondrial calcium overload: a general mechanism for cell-necrosis in muscle diseases. Lancet 1976;1:672-4.
  40. Vanholder R, Sever MS, Erek E, Lameire N. Rhabdomyolysis. J Am Soc Nephrol 2000;11:1553-61.
  41. Cole L, Bellomo R, Silvester W, Reeves JH. A prospective, multicenter study of the epidemiology, management, and outcome of severe acute renal failure in a “closed” ICU system. Am J Respir Crit Care Med 2000;162:191-6.
  42. Reinhardt GF, Myscofski JW, Wilkens DB, Dobrin PB, Mangan JE Jr, Stannard RT. Incidence and mortality of hypoalbuminemic patients in hospitalized veterans. J Parenter Enteral Nutr 1980;4:357-9.
  43. Abernethy VE, Lieberthal W. Acute renal failure in the critically ill patient. Crit Care Clin 2002;18:203-22.
  44. Schor N. Acute renal failure and the sepsis syndrome. Kidney Int 2002;61:764-76.
  45. Schrier RW, Wang W. Acute renal failure and sepsis. N Engl J Med 2004;351:159-69.
  46. Silvester W, Bellomo R, Cole L. Epidemiology, management, and outcome of severe acute renal failure of critical illness in Australia. Crit Care Med 2001;29:1910-5.
  47. Harmann PK, Kron IL, McLachaln HD, Freedlender AE, Nolan SP. Elevated intra-abdominal pressure and renal function. Ann Surg 1982;196:594-7.
  48. Brezis M, Agmon Y, Epstein FH. Determinants of intrarenal oxygenation. I. Effects of diuretics. Am J Physiol 1994;267:1059-62.
  49. Heyman SN, Rosen S, Epstein FH, Spokes K, Brezis ML. Loop diuretics reduce hypoxic damage to proximal tubules of the isolated perfused rat kidney. Kidney Int 1994;45:981-5.
  50. Mehta RL, Pascual MT, Soroko S, Chertow GM, PICARD Study Group. Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA 2002;288:2547-53.
  51. Crowley ST, Peixoto AJ. Acute Kidney Injury in the Intensive Care Unit. Clin Chest Med 2009;30:29-43.
  52. Ricci Z, Cruz D, Ronco C. The RIFLE criteria and mortality in acute kidney injury: a systematic review. Kidney Int 2008;73:538-46.
  53. Bagshaw SM, George C, Gibney RT, Bellomo R. A multi-center evaluation of early acute kidney injury in critically ill trauma patients. Ren Fail 2008;30:581-9.
  54. Yuan F, Hou FF, Wu Q, Chen PY, Xie D, Zhang X. Natural history and impact on outcomes of acute kidney injury in patients with road traffic injury. Clin Nephrol 2009;71:669-79.
  55. Gomes E, Antunes R, Dias C, Araϊjo R, Costa-Pereira A. Acute kidney injury in severe trauma assessed by RIFLE criteria: a common feature without implications on mortality? Scand J Trauma Resusc Emerg Med 2010;18:1.
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