Acute Renal Failure of Nosocomial Origin.

Authors:
Mark Dominik Alscher
Mark Dominik Alscher
Robert-Bosch-Hospital
Christiane Erley
Christiane Erley
University of Tuebingen
Germany
Martin K Kuhlmann
Martin K Kuhlmann
Renal Research Institute
United States

Dtsch Arztebl Int 2019 03;116(9):149-158

Background: 10-20% of hospitalized patients develop acute kidney injury (AKI)/acute renal failure during their hospital stay. The mortality of nosocomial AKI is approximately 30%.

Methods: This review is based on relevant publications retrieved by a search in multiple databases (PubMed and Uptodate), archives, and pertinent medical journals.

Results: The most common causes of nosocomial AKI are volume depletion, sepsis, heart diseases, polytrauma, liver diseases, and drug toxicity. AKI can also be of postrenal (obstructive) origin, or a result of renal diseases including glomeruloneph- ritis, vasculitis, tubulointerstitial nephritis, and cholesterol embolism. In about 13% of cases, nosocomial AKI develops on the basis of pre-existing chronic renal disease. Patients with AKI are at elevated risk of developing chronic renal disease and must be followed up appropriately after they are discharged from the hospital. Indispens- able elements of the evaluation of nosocomial AKI include renal ultrasonography, the exclusion of postrenal obstruction, urine chemistry, and microbiological urinaly- sis. Potentially nephrotoxic drugs and those that impair renal hemodynamics must be avoided to the greatest possible extent in patients with acute renal damage. Hypotension must be avoided as well.

Conclusion: Early, specific nephrological diagnosis and treatment are important components of the management of nosocomial AKI, particularly because causally directed treatment is available for some of the conditions that underlie it.

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Source
http://dx.doi.org/10.3238/arztebl.2019.0149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6460009PMC
March 2019
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