By J. S. Cameron (auth.), David Bihari MA, MRCP, Guy Neild MD, FRCP (eds.)
A workshop was once organised as a way to in attaining multi-discipli- nary evaluate of the pathogenesis and administration of acute failure, quite because it happens and is controlled in extensive remedy devices. The e-book offers with the realities and practicalities of this significant sector of acute drugs. each one bankruptcy is through a dialogue, in order that a concen- sus view is bought from a global physique of experts.
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Moreover, an accurate prognostic index can be obtained by counting the number of organ systems in failure (Cameron 1986). The main features of ARF in multidisciplinary, surgical and medical ICUshave recently been assessed in a large multicentre study involving 38 intensive care units (Bobrie and Patois 1987). 8%) had ARF. 5% in total patients hospitalized in ICUs); (c) factors influencing a poor prognosis included a high simplified acute physiologic score (SAPS), a poor previous health status assessed 3 months prior to hospitalization, associated mechanical ventilation (60% mortality vs 30% in non-ventilated patients), and the presence of oliguria (53% mortality vs 35% in non-oliguric patients); (d) age did not influence mortality, whereas mortality increased with age in patients without ARF.
8%). No patient died in the glafenin group. Advanced age, oliguria, a high maximal serum creatinine level and pre-existing cardiac, hepatic or renal insufficiency were of bad prognosis. In general, the survival rate of drug-induced ARF is much better than that of any other type of ARF, excluding acute glomerulonephritis. The incidence of residual renal damage increases sharply in patients with acute interstitial nephritis (60%) compared to those with acute tubular necrosis (16%) (Kleinknecht et al.
1). The emphasis has gradually shifted from characterization and dialytic treatment to prevention, early diagnosis, and specific pharmacological therapies. The first prospective human trials of intervention with atrial natriuretic peptide, calcium channel blockers, thyroxine, and oxygen free radical scavengers are just now getting underway, after many years of studies confined to the laboratory. It is likely that in the next few years an agent will be found which is as effective in reversing early acute renal failure as tissue plasminogen activator is in reversing early myocardial infarction (Thrombolysis in Myocardial Infarction Study Group 1985).