Plasma concentrations of tumor necrosis factor alpha may predict the outcome of patients with acute renal failure

Background/Aims: Elevated plasma tumor necrosis factor-alpha (TNF alpha) concentration is frequently found in patients with chronic renal failure on hemodialysis (HD) and correlates with their mortality. The present study aimed to analyze the relationship between plasma TNF alpha concentrations and survival of patients with nonseptic acute renal failure (ARF). Methods: Twenty-seven patients with ARF and 27 HD patients were examined. In ARF the patients' plasma TNF alpha concentrations were assessed 3 times: before the first HD session (phase I), 5 days later at the anuric/oliguric phase (phase II), and at the polyuric phase at discharge of the patients from the hospital (phase III). In 17 ARF patients kidney function recovered and 10 patients died in phase I. Results: In ARF patients plasma TNF alpha concentration was markedly higher [70 pg/ml (37-275)] than reference values (< 5 pg/ml) but significantly lower than in HD patients [216 pg/ml (18-350)]. Moreover, also plasma TNF alpha levels at the polyuric phase remained elevated. An initial plasma TNF alpha concentration in ARF patients lower than 70 pg/ml predicted the beneficial outcome with a sensitivity of 64.7% and a specificity of 70.0%. Conclusions: (1) Plasma TNF alpha concentration may predict the outcome in patients with ARF. (2) Plasma TNF alpha concentration remained elevated at the polyuric phase in ARF despite a marked improvement of excretory kidney function. Copyright (c) 2006 S. Karger AG, Basel.