الفهرس 
Acute Renal FailureOnly 14 pages are availabe for public view
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Abstract
Acute kidney injury (AKI) affects 5 to 7% of all hospitalized patients, and despite technological advances, it continues to be associated with poor outcomes.
This syndrome is common in the intensive care unit (ICU), with a reported incidence of 1 to 25% depending on the population being studied and the criteria used to define its presence.
AKI in this setting is associated with mortality rates of 50 to 70%, which have remained relatively constant in the past decades.
A practical definition should be based on widely accepted foundations of pathophysiology, clinical behavior and response to treatment, histopathologic features, and prognosis.
Given the heterogeneity of ARF and the absence of specific markers for renal injury, an effective diagnostic and classification scheme should consider parameters other than the renal response to injury.
Accordingly, ADQI advocated a multilevel classification system in which a wide range of disease spectra can be included. The resulting classification, based on these considerations, is called RIFLE (acronym indicating Risk for renal dysfunction, Injury to the kidney, Failure of kidney function, Loss of kidney function, to the 3 levels of renal dysfunction, also includes 2 clinical outcomes: “loss” and “end stage renal disease .
These are separated to acknowledge the important adaptations that occur in patients with end-stage renal disease that are not seen in those with persistent ARF. Persistent ARF (loss) is defined as the need for renal replacement therapy (RRT) for more than 4 weeks, whereas end-stage renal disease is defined as the need for dialysis therapy for longer than 3 months.
The present study was conducted at the intensive care unit in Nasser institute in the period between the between the 1st of march 2008 and 30th April 2008 (2 months) and 1 month follow up after discharge to whom discharged with residual kidney damage. A total number of 50 cases were admitted to Nasser institute hospital medical ICU in Cairo, 15 of them were excluded from the study (10 died in the first day and 5 were having chronic kidney disease). A total number of 35 adult patients studied.
The aim was to investigate the possible value of RIFLE criteria in prediction of outcome in intensive care unit patients.
We found that the incidence of ICU acquired acute renal insult in this study was found to be 62 %. In our study we found that the majority of patients included in the present study were classified as “Failure”, according to RIFLE criteria. The failure group included 9 patients and the mortality was 4 patients (44.4%) it was significancant (p =0.018) and the (R) category 6 patients and the mortality was 1 (16.7%).
We found increasing severity of illness, more aberrant changes in acute physiology and more abnormal laboratory values with each worsening RIFLE category. We also found that worsening RIFLE category correlated with an increasing linear trend in hospital mortality. Overall, we found that the RIFLE classification was robust and correlated well with hospital mortality. The RIFLE criteria as a whole has a sensitive test to predict the outcome (78.3%), specificity of 66.7%, positive predictive value (ppv) of 81.8%, negative predictive value 61.5%, it wasn’t very high as the number of patient was low .We apply each category alone as a predictor of the outcome and it was found that the failure category has the highest sensitivity and specificity. Applying the new ADQI group classification system (RIFLE) helped us establish that patients with severe ARF (failure group) had the worst prognostic factors for patient and kidney survival.