Acute renal insufficiency is a severe, but most frequent reversible illness followed by sudden onset,
oliguria or
anuria of indefinite duration, by rapid increase in decomposition products of
protein catabolism in serum, by
acidosis and fluid balance and
electrolytes disorder. The aetiologic factors of
acute renal insufficiency are various. A very significant aetiological factor in the appearance of
acute renal insufficiency is a
trauma caused by any kind or type of weapons, arms or instruments [1-5, 6, 9-13, 15]. Of a total number of injured persons who were treated in our institution (4,086 injured persons), 251 (6.14 percent) were with
acute renal insufficiency, and of that number with all signs and symptoms of
acute renal insufficiency 37 (0.9 percent) were treated with haemodialysis. Of the number of dialysed patients 30 (80 percent) patients had oliguric form of
acute renal insufficiency and 7 (19 percent) were with non oliguric form of
acute renal insufficiency. The most frequent
injuries were to abdomen and then to extremities, liver, chest and kidneys. The smallest percentage concerned isolated
injuries in extremities. According to a pathogenic mortality mechanism, the highest mortality was in patients with haemorrhagic syndrome and in septic condition, and the minimal in patients with other syndromes, such as
crush syndrome, etc. In 25 (68 percent) patients
acute renal insufficiency was associated with haemorrhagic syndrome, in 7 (18.9 percent) with
crush syndrome and in 5 (13.5 percent) with septic condition. In 36 (97 percent) patients haemodialysis was performed and in 1 (3 percent) subject
peritoneal dialysis. The reason for such a small number of
peritoneal dialysis are severe
injuries to abdomen and chest, since this type of dialysis could not be performed for technical reasons. In 27 (73 percent) patients haemodialysis was performed as a type of intermittent heparinization. In 5 (14 percent) patients heparinization was a type of continual heparinization. Thanks to prompt haemodialysis together with medical
therapy and surgical treatment, the mortality rate in our patients was lower in comparison to mortality rate in other centres (Table 3). The main causes of
acute renal insufficiency in our patients were: Acute tubular nercosis, peripheral blood flow insufficiency (hypovolaemia, cardiovascular failure), and postrenal insufficiency (excretory obstruction, intrarenal obstruction, urinary organ
ruptures, haemorrhagic
shock) and the underlaying
kidney disease.
Acute renal insufficiency can be divided into
acute renal insufficiency, primary parenchymal
renal insufficiency and postrenal
azotaemia [1-6, 9, 12, 13]. During the
therapy of these patients it is important to evaluate the
dehydration degree of patients by clinical and laboratory parameters. In case of hypovolaemia the complete compensation of fluid should consist of infusion together with administration of
diuretics. The central venous pressure should be maintained at the values in a range from 6 to 8 cm H2O. In case of oliguric
acute renal insufficiency the fluid intake should be equal to diuresis plus every other loss of fluids. Diet should be high-caloric with
carbohydrates in the amount of 100 mg, and that amount should be given three to four times daily (both parenterally and orally) together with restriction of
potassium intake due to a well known effect of
potassium on myocardium function. Dosage of drugs which are eliminated via kidney should be managed promptly by parenteral administration of
antibiotic agents [7, 8, 13-16]. Haemodialysis should be started at the very beginning of the patients admission to the hospital and should be associated with
anticoagulant therapy for avoiding haemorrhages. Thanks to haemodialysis performed in time, the mortality rate in our patients was reduced in comparison to health centres where haemodialysis was delayed. Thanks to such treatment of patients with many severe
injuries in whom the mortality rate is usuall