ACUTE-RENAL-FAILURE IN RENAL-ALLOGRAFT RECIPIENTS AND PATIENTS WITH NATIVE KIDNEYS

In order to evaluate the role of underlying disease in the high mortal ity observed in acute renal failure (ARF) and risk factors related to the development of oliguric ARF in renal allograft recipients, two gro ups were selected: 34 patients with native kidneys, aged 16 and 57 yea rs, and presenting ischemic ARF caused by cardiovascular collapse, wit h no signs of infection at the time of diagnosis; and 34 renal allogra ft recipients who developed ARF immediately after transplantation, wit hout rejection. ARF was defined either as 30% increase of basal plasma tic creatinine in patients with native kidneys or non-normalization of plasmatic creatinine at day 5 after transplantation in renal allograf t recipients; oliguria as diuresis less than or equal to 400 mL/24 h. There were no differences in age, male frequency, oliguria presence an d duration, need for dialysis, and infection episodes for renal allogr aft recipients and patients with native kidneys. The development of se psis (3% and 41%) and death rate (3% and 44%) were higher in patients with native kidneys (p < 0.01). The renal allograft recipients with bo th oliguric (n = 18) and nonoliguric (n = 16) ARF were evaluated and n o difference was observed in the recipient's age, donor's age, cold is chemia time, rime elapsed until plasmatic creatinine normalization, do nor's plasmatic creatinine or urea, and mean arterial pressure. No dif ferences were observed between the groups regarding frequency of infec tion episodes during ARF and frequency of death. In conclusion, renal allograft recipients presented a fewer death rate and were less suscep tible to sepsis. Cold ischemia time, age, and hemodynamic characterist ics of the donor did not affect the development of oliguria.