In the present study we highlight the epidemiology, etiologic spectrum, and evaluation of ARF in adults. We then expand on the pathophysiologic mechanisms of
renal failure and discuss the rationale for current therapeutic strategies in ARF patients. A total of 79 patients (45 male, female 34), aged 18-75 years (median age 51.2 +/- 17.7 years) with
acute renal failure were studied in 5 years (January 1990 through October 1995). Emergency
hemodialysis sessions following an acute anuric episode were instituted in 39 cases (49.3% of all patients). The median number of
hemodialysis procedures per patient treated at our institution was 3.2 +/- 1.9. The total number of acute
interstitial nephritis-associated ARF was 40. In 30 of them (75%) the acute renal insult included a combination of several therapeutic
antimicrobial agents, in 2 cases (5%) ARF followed the administration of nonsteroidal anti-inflammatory drugs, in 1 (2.5%) it resulted from a combined therapeutic regimen and in the remaining 5 (12.5%) from the application of a single
drug. Acute
interstitial nephritis developed in 2 patients following a
viral infection. In the
hemodialysis-treated ARF group 12 patients (29.77%) had
interstitial nephritis and 2 patients (5.13%) presented with renal impairment for an unspecified period of time preceding the development of overt ARF. In a subset of this group of patients, ARF occurred in 7 patients (17.95%) following an urologic intervention, in 8 patients (20.51%) as a consequence of thermal or mechanical
trauma or intoxication and in 3 cases (7.69%) it resulted from
fever of unknown origin. Three patients with postoperative
peritonitis and 4 other (10.26%) with postoperative complications were encountered in our series. No cases of
septic abortion-related or obstetric-related ARF were recorded. 92.3% of all
hemodialysis-treated patients seen at our Institution had received a combination of
antibiotics and only 2 patients had been pre-treated with a single
antimicrobial agent. Our results underscore the strong tendency towards diversity in the etiologic spectrum of clinical entities causing ARF and the increase in the number of acute
interstitial nephritis. These factors highlight the importance of precise dosing and administration of drugs, especially
antibiotics, as well as the duration of
antibiotic treatment.