ETIOLOGY OF ACUTE-RENAL-FAILURE

We analyzed the etiology of acute renal failure (= ARF) in two patients cohorts at the Basel Kantonsspital (University Hospital). First group: 121 patients with acute rise of serum creatinine seen by nephrologic consultants (1986-1989). Second group: 90 consecutive patients treated by acute hemodialysis because of ARF (1980-1985). Drug-induced ARF was the major etiology in the first group (29/121=24%) and mefenamic acid (Ponstan) the "leading" single substance (11/29). In the second group septic shock was the major cause of ARF (38/90=42%). Septic shock is defined as infection with hypotension, severe enough to be treated i.v. with vasoactive substances. The overall mortality in the second group was 62% (56/90), but as high as 82% in the subgroup with septic shock (31/38). Treatment of infection is the first priority. As long as the infection remains uncontrolled, early and intensive hemodialysis will not improve the poor prognosis.