OUTCOME OF ACUTE-RENAL-FAILURE IN MENINGOCOCCEMIA

We studied 28 consecutive patients (18 males and 10 females), 1-32 yea rs of age, admitted to the intensive care unit from January 1989 to Ju ly 1995, with acute renal failure (ARF) due to meningococcal septicemi a. All patients were treated with dexamethasone, penicillin, and/or ch loramphenicol. Twenty-two patients presented septic shock and need flu id replacement and vasoactive drugs. Acute renal failure was oliguric in 67.8%. Maximum levels of blood urea and serum creatinine were 210.3 +/- 26.6 mg/dL and 6.9 +/- 1.3 mg/dL, respectively. Metabolic acidosi s was observed in 89.3% and hyperkalemia in 43%. The fractional excret ion of sodium on day I was high (9.9 +/- 0.6%). The urinalysis did not show trace protein, but hematuria was positive in 81%. The mortality rate was 63.3%. In the 10 survivors, oliguria was present for a period of 12.7 +/- 2.4 days, and the period to reach a normal serum creatini ne level was 20.2 +/- 4.7 days, although in two female patients, 7 and 17 years old, the elevated serum creatinine persisted. Renal biopsy w as performed in one of these patients which revealed bilateral cortica l necrosis. These data show that acute renal failure in meningococcemi a presents high mortality rate associated to shock; 80% of the survivo rs recover renal function; and bilateral cortical necrosis occurred in one patient in this series.