CHARACTERISTICS OF ACUTE-RENAL-FAILURE IN A SMALL-TOWN HOSPITAL

During two consecutive years we studied prospectively one hundred and fourty eight patients with acute renal failure (ARF) diagnosed on conv entional criteria, an incidence of 493 cases per million population pe r year. We analyzed age, sex, serum creatinine, diuresis, type and sub tipe of ARF, need for and type of dialysis, outcome, cause of admissio n and presence of preexisting chronic diseases. Acute renal failure af fected of 0.77% of patients admitted to hospital, rising to 1.99% for patients over 65. The commonest form of ARF was pre-renal uraemia, par ticulary in those who contracted it outside hospital. Pre-existing chr onic diseases were common (59.4%), the most frequent being hypertensio n and diabetes. The commonest cause of admission was severe pulmonary infection. 42% of patients recovered renal function at to discharge fr om hospital; 24.3% did not recovered their original function, one pati ent required long term haemodialysis and 33.1% died. Fifteen per cent of patients required dialysis during their ARF. The commonest causes o f ARF arising in hospital were prerenal uraemia and acute tubular necr osis (ATN). ATN had a high mortality (53.4%); among those with toxic A TN a common cause was incorrect dosage of aminoglucosides. An institut ional policy is necessary to reduce the rate of ARF.