BASIC THERAPEUTIC REQUIREMENTS IN THE TREATMENT OF SEPSIS IN ACUTE-RENAL-FAILURE

Acute renal failure (ARF) is a common manifestation of a septic condit ion which very often complicates surgical and traumatic events. The re lease of endotoxin, a lipopolysaccharide (LPS) from the cell wall of G ram-negative bacteria, and subsequently of numerous host mediators, is the initiating event of sepsis syndrome and eventually of septic shoc k. Particularly interesting is the observation that not only endotoxin s but also Staphylococcus aureus which does not produce endotoxins ind uce the same cardiovascular changes of septic shock. The main aspect o f septic shock is the inadequate oxygen supply to the body tissues. Ho wever, despite the documented myocardial depression in the course of s eptic shock, myocardial ischaemia is not to be considered a contributi ng factor, and the coronary blood flow is normal or even increased. Pr otein hypercatabolism can be at best only limited; in any case the opt imal protein-sparing effect was observed with 1.5 g/kg proteins. Recen tly monoclonal antibodies to endotoxin core glycolipid have been devel oped; they are: (a) E5, a murine IgM anti-lipid A monoclonal antibody; (b) HA-1A, a human monoclonal antibody to endotoxin core glycolipid. In conclusion, hypercatabolic septic patients should be managed in an intensive care environment where a continuous monitoring of fluids, el ectrolytes, and acid-base disorders can be achieved. Surgical search o f septic foci, and wide-spectrum antibiotic therapy are fundamental me asures to combat cytokine and vasodilator production which impair tiss ue perfusion and create the premise of a shock status complicated by l actic acidosis. Dialysis treatment is a further complementary but fund amental approach that allows a large fluid and nutritional intake and a continuous correction of electrolyte and acid-base disorders.