SEPSIS-INDUCED ACUTE-RENAL-FAILURE - UNUSUAL CLINICAL PRESENTATION

We report 4 cases of sepsis-induced acute renal failure (ARF) with pec uliar clinical presentation in which the renal biopsy was the only clu e to a correct diagnosis. We observed 66 cases of ARF in a 4-year expe rience. Seven (11%) were associated with sepsis; in 3 of these (4.5%) a shock was present. Clinical picture of the remaining 4 cases (6%) wa s characterized by ARF with oligoanuria and proteinuria (> 2 g/L), fev er, resistant to antimicrobial therapy, negative hemocultures and seve re systemic symptoms. Such a presentation could suggest a non-infectio us systemic disease; renal biopsies were carried out. Histological fin dings consisted of microabscesses of variable size in the interstitium and within the tubular lumina. A full-dose, broad-spectrum, i.v. anti microbial therapy was started, with favourable outcome and recovery of renal function. Our clinical experience points out that the clinical picture of ARF in course of sepsis may be variable and that its relati onship with septicaemia could not be readily discernible.