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        "resumen" => "Introducción: Las causas más comunes de insuficiencia renal aguda en las unidades de cuidados intensivos son la sepsis severa y el choque séptico. La mortalidad reportada en los pacientes con sepsis severa e IRA es hasta del 70%. La fisiopatología propuesta para la falla renal en la sepsis grave incluye una combinación de factores como hipotensión sistémica, vasoconstricción renal, infiltración de células inflamatorias en el riñón, trombosis intraglomerular y obstrucción intratubular. Objetivos: Mostrar la incidencia, mortalidad y la histología de la insuficiencia renal aguda causada por sepsis severa. Diseño del estudio: Retrospectivo, descriptivo y transversal. Metodología: Se estudiaron retrospectivamente los casos de 332 pacientes con el diagnóstico de sepsis severa que fueron hospitalizados en la Unidad de Cuidados Intensivos del Hospital General del Centro Médico Nacional en el lapso de un lustro. De este total de pacientes 107 presentaron insuficiencia renal aguda secundaria a dicho proceso séptico. El diagnóstico se efectuó con base en las alteraciones de las pruebas funcionales renales (DCr, DmOms, DH20, U/PmOsm, FENA, FEK y IFR). Los pacientes fueron tratados de dos modos distintos, mediante manejo médico (70%) o con hemodiálisis (30%). A 40 de ellos se les tomó biopsia renal percutánea entre los seis y siete días posteriores a su diagnóstico. Todas las biopsias fueron estudiadas por microscopia óptica. Resultados: Del grupo de 332 pacientes con sepsis severa 107 presentó insuficiencia renal aguda, lo que representa el 32,22% de la población en este grupo 40 pacientes (100%) a los que se les tomó biopsia renal&#59; 20 pacientes (50%) tuvieron necrosis tubulointersticial, 11 pacientes (27,5%) desarrollaron lesión glomerular y tubular, y el resto 9 pacientes (22,5%) presentaron lesión glomerular y vascular. La mortalidad para el grupo tratado con manejo médico fue del 69,3%, mientras que la del grupo tratado con hemodiálisis fue del 28,1%. Discusión: Es necesario generar conocimientos más exactos sobre la génesis y desarrollo de la IRA en el paciente séptico, ya que la mortalidad en estos pacientes continua siendo elevada a pesar del inicio de diálisis temprana en cualquiera de sus modalidades, aun con las de reemplazo renal continuo."
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Severe sepsis as a cause of acute renal failure
SEPSIS SEVERA COMO CAUSA DE FALLA RENAL AGUDA
M. Diaz de León, SA. Moreno, DJ. Gonzalez, GJ. Briones
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    "titulo" => "Severe sepsis as a cause of acute renal failure"
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        "autoresLista" => "M. Diaz de León, SA. Moreno, DJ. Gonzalez, GJ. Briones"
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        "titulo" => "SEPSIS SEVERA COMO CAUSA DE FALLA RENAL AGUDA"
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        "resumen" => "Introducción: Las causas más comunes de insuficiencia renal aguda en las unidades de cuidados intensivos son la sepsis severa y el choque séptico. La mortalidad reportada en los pacientes con sepsis severa e IRA es hasta del 70%. La fisiopatología propuesta para la falla renal en la sepsis grave incluye una combinación de factores como hipotensión sistémica, vasoconstricción renal, infiltración de células inflamatorias en el riñón, trombosis intraglomerular y obstrucción intratubular. Objetivos: Mostrar la incidencia, mortalidad y la histología de la insuficiencia renal aguda causada por sepsis severa. Diseño del estudio: Retrospectivo, descriptivo y transversal. Metodología: Se estudiaron retrospectivamente los casos de 332 pacientes con el diagnóstico de sepsis severa que fueron hospitalizados en la Unidad de Cuidados Intensivos del Hospital General del Centro Médico Nacional en el lapso de un lustro. De este total de pacientes 107 presentaron insuficiencia renal aguda secundaria a dicho proceso séptico. El diagnóstico se efectuó con base en las alteraciones de las pruebas funcionales renales (DCr, DmOms, DH20, U/PmOsm, FENA, FEK y IFR). Los pacientes fueron tratados de dos modos distintos, mediante manejo médico (70%) o con hemodiálisis (30%). A 40 de ellos se les tomó biopsia renal percutánea entre los seis y siete días posteriores a su diagnóstico. Todas las biopsias fueron estudiadas por microscopia óptica. Resultados: Del grupo de 332 pacientes con sepsis severa 107 presentó insuficiencia renal aguda, lo que representa el 32,22% de la población en este grupo 40 pacientes (100%) a los que se les tomó biopsia renal&#59; 20 pacientes (50%) tuvieron necrosis tubulointersticial, 11 pacientes (27,5%) desarrollaron lesión glomerular y tubular, y el resto 9 pacientes (22,5%) presentaron lesión glomerular y vascular. La mortalidad para el grupo tratado con manejo médico fue del 69,3%, mientras que la del grupo tratado con hemodiálisis fue del 28,1%. Discusión: Es necesario generar conocimientos más exactos sobre la génesis y desarrollo de la IRA en el paciente séptico, ya que la mortalidad en estos pacientes continua siendo elevada a pesar del inicio de diálisis temprana en cualquiera de sus modalidades, aun con las de reemplazo renal continuo."
      ]
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        "resumen" => "Introduction: The most common causes of acute renal failure in the intensive care units are severe sepsis and septic shock. Mortality reported in this kind of patients is about 70%. The pathophysiology of acute renal failure in severe sepsis includes systemic hypotension, direct renal vasoconstriction, infiltration of the kidney by inflammatory cells, renal ischemia, intraglomerular thrombosis and intratubular obstruction. Objective: To show the incidence, mortality and histopathological etiology of acute renal failure in severe sepsis. Type study: Retrospective, transversal and descriptive. Methods: We study 332 cases of patients with severe sepsis, who were hospitalized in the Intensive Care Unit of Hospital General del Centro Médico Nacional, during five years. From these patients 107 developed acute renal failure due to severe sepsis. This group recived two differet kind of treatment, medical management (70%) and hemodyalisis (30%). Renal biopsy was taken in 40 patients after six or seven days of the diagnosis of acute renal failure caused by severe sepsis. Results: In the group of 332 patients with severe sepsis 107 developed acute renal failure, this represents the 32.22%. The group of patients with renal biopsy presented the following results: 50% had acute tubular necrosis, 27.5% presented glomerular and tubular lesion, the rest 22.5% had glomerular and vascular lesion. The mortality for patients treated with medical management was of 69.3%, and for those treated with hemodyalisis was of 28.1%. Discussion: Nowadays, and due to the high incidence and mortality of this disease, is very important to generate more concise knowledge about the genesis and development of acute renal failure in the septic patient."
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Article information
ISSN: 20132514
Original language: English
DOI:
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