This prospective study was carried out at nephrology unit of Sindh Institute of Urology and Transplantation (SIUT) Pakistan, from November 2012 to May 2013. SIUT is a big tertiary care center for nephro-urology patients. All adult patients with known underlying diabetes presenting with suspected acute renal failure in the setting of recognizable acute insult were included in the study. For the purpose of this study ARF was considered
A) Definite: when
1. Diabetic patients with known baseline creatinine experienced ≥ 50% increase in serum creatinine during acute illness requiring hospitalization.
2. When baseline values were not available ARF was considered to be present at the end of six weeks if
• Patient requiring dialysis became dialysis free.
• Patient treated conservatively experienced ≥ 50% reduction in serum creatinine from admission value.
B) Probable: when
Diabetic patients presenting with renal failure following an acute insult, in whom baseline creatinine was not known, and who failed to recover renal function or died during treatment before recovering renal function during first six weeks.
Following patients were excluded from the study;
1. Patients with known diabetes with documented progressive decline in renal function requiring dialysis.
2. Patients with known diabetes, admitted with renal failure, in whom renal functions were never checked in the past and had no preceding history of any acute event.
3. Diabetic patients with renal transplant.
A detailed history was taken regarding duration of diabetes, smoking, associated hypertension, coronary artery disease, any intervention done, drug history especially of ACEI/ARB, NASIDS and diuretics. Last outpatient serum creatinine if available and serum creatinine on a...
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... in two groups by treatment modality used, dialysis or conservative treatment. 72 (75.8%) patients required dialysis, while remaining 23 (24.2%) were managed conservatively. 47 (65.3%) remained on dialysis for < 2 weeks, and 25 (34.7%) remained dialysis dependent for > 2 weeks (2-6 weeks). Outcome of study is shown in figure 1. 62 (67.39%) patients recovered, 14 (15.21%) became dialysis dependent and 16 (17.39%) died. Among those who recovered by the end of the study, 21 (33.8%) were managed conservatively, while 41 (66.12%) were dialyzed temporarily. Table 3. Among those who expired 16 (17.39%), all underwent dialysis and sepsis 13 (81.25%) being the leading cause of death. Follow up mean creatinine in recovered patients after 6 weeks came out to be 2.47mg/dl ± 1.23 s.d. treated conservatively, whereas in patients requiring dialysis it was 3.65mg/dl ± 1.65 s.d.