Evaluation of Clinical Profile of Renal Failure: A Study of 153 patients

INTRODUCTION: Renal failure is an important medical complication for which patients are admitted in medical wards. Renal failure is classified as Acute Renal Failure (ARF) and Chronic Kidney Disease (CKD). ARF is a reversible renal disease, while CKD is an irreversible renal disease. On admission, it may be difficult to diagnose ARF or CRF and further evaluation is required to confirm the diagnosis. In our Hospital, these patients were admitted in the Medical Units, Nephrology Department or the Intensive Medical Care Unit. In this study patients admitted and diagnosed to have renal failure in medical units only were analysed. Acute diarrheal disease is the most common cause of ARF. Chronic glomerulonephritis is the most common cause of CKD which was closely followed by Diabetic Nephropathy. The study was done in Stanley Medical college Hospital, which is located in North Chennai. This study deals with etiological, clinical and laboratory profile of renal failure. AIM OF THE STUDY: 1. To evaluate the type of renal failure (ARF/CKD) admitted in the medical units. 2. To analyse the etiology, clinical features and management of ARF. 3. To analyse the etilogy, clinical feature and management of CKD. PATIENTS AND METHODS: Patients aged 13 and above, admitted to the medical units of Government Stanley Hospital with Serum Creatinine > 1.5 mg/dl were taken up for the study. They were further subdivided into: a. Acute Renal Failure (ARF). b. Chronic Kidney Disease (CKD). 2. The following criteria were used for selecting patients for ARF and CKD. a. ARF: • Patients with Serum Creatinine > 1.5 mg/dl in whom the renal failure was reversible with treatment. • Rapid onset of renal failure. • Normal sized Kidneys. b. CKD: • Patients with Serum Creatinine > 1.5 mg/dl, whom the renal failure was not reversible with treatment. • Gradual onset of renal failure. Exclusion Criteria: Patients admitted in Intensive Medical Care Unit and Nephrology Department were not taken up for the study. Patients admitted in the IMCU had mostly hospital acquired ARF and it has a high mortality rate (40-70%). The nephrology department was a referral centre and patients there do not comprise the model of the local population in Chennai. SUMMARY: 153 patients with S.Creatinine >1.5 mg% were analysed in our study. 71 (46%) had ARF and 82 (54%) had CKD. • The most common etiology of ARF was acute diarrheal diseases (16%), followed by malaria, leptospirosis, CCF, sepsis, drugs and AGN. Infective diseases contributed to > 50% of the ARF. • The most common symptom of ARF was fever (62%), followed by vomiting, giddiness and breathlessness. Oliguria occurred only in 28% of the patients. The most common sign was anemia (34%). Jaundice occurred in 8% of the patients. • Of all the common causes of ARF, malaria caused severe renal failure with mean S.creatinine of 4.2 mg%, followed by drugs and sepsis. Most of the patients with CCF were dyspneic. Anemia occurred commonly in malaria. Oliguria occurred commonly in ADD and malaria. • 13% of patients with ARF had hypotension. 55% of the patients were anemic. The mean B. urea was 79 mg% and the mean S.creatinine was 2.7 mg%. 34% of patients had hyponatremia and 10% had hyperkalemia and 11% had significant proteinuria. • 1 patient had peritoneal dialysis and 2 patiens had hemodialysis. All others were managed conservatively. Two patients who had severe renal failure and uremic coma died. • 82 (54%) patients had CKD. The most common etiology of CKD was CGN (49%), followed by DN (37%) and obstructive uropathy. There was male preponderance in CGN and female preponderance in DN. • Pedal edema was commonest symptom followed by oliguria (54%). Anemia was present in 57% of the patients. Volume overload was present in >20% of patients. • 45% of patients had history of SHT and 20% were known cases of CKD. On examination 72% of the patients were hypertensive. 13% had malignant hypertension. • 61% of CKD patients were anemic. The mean serum creatinine 3.7 mg% and 12% of the patients had hyperkalemia. 76% of patients with CKD had proteinuria in varying degrees. • 38% of patients had evidence left ventricular hypertrophy in ECG. 53% of patients with CKD had cardiomegaly in Chest X-Ray. 71% had contracted kidneys. • Hemodialysis was started for 6 patients. Out of these 5 were enrolled for renal transplantation program. 5 patients were put on peritoneal dialysis. Mortality was 1%. CONCLUSIONS: ARF occurred in 46% of patients and CKD in 54% of patients. • The commonest cause of ARF is Acute diarrheal diseases. Infections (malaria, Leptospirosis, sepsis) contributed to >50% of ARF. Most of the patients with ARF had mild renal failure, which contributed to the lesser requirement of dialysis and low mortality rate. • The commonest cause of CKD was CGN (49%) followed by DN (45%). 72% of patients had SHT. 57% had anemia. Since the prevalence of DM is increasing day by day, early diagnosis of DN by routine screening and retarding the progression by using ACEI or ARB will decrease the incidence of ESRD patients. • Early diagnosis of renal failure utilizing S.Creatinine ≥ 1.5 mg/dl was essential to diagnose and prevent complications of acute and chronic renal failure