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Title: Factors affecting the outcome of patients with acute renal failure
Author: Shilliday, Ilona R.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1997
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The principle aim of this thesis is to examine the hypothesis that patients with acute renal failure (ARF) who are treated with high dose loop diuretics have a better prognosis in terms of survival, need for dialysis and speed of recovery than those who do not receive these drugs. A prospective, double blind, randomised, placebo controlled study was carried out on 94 patients with ARF in Glasgow Royal Infirmary. The use of loop diuretics caused a significant increase in urine output and fractional excretion of sodium in the first 24 hours, but had no effect on the final outcome (recovery, dialysis or death) at day 21. Patients who became non-oliguric (with or without loop diuretics) had a better survival but were less ill (APACHE II score 17.2 v 20.6, p=0.007, non-oliguric v oliguric) and had less severe renal failure (creatinine clearance 14ml/min v 4.5ml/min, p < 0.0001) than those who remained oliguric. Loop diuretics can lower cytosolic calcium in normal individuals and in those with hypertension. Because cell death has been shown to be accompanied by a rise in intracellular calcium, I postulated that cytosolic calcium levels would be high in patients with ARF. Further, the use of loop diuretics might lower cytosolic calcium in patients with ARF and thereby exert a beneficial effect on renal tubule cells. Intraplatelet calcium levels were high in patients with ARF compared to normal controls (109nm v 92.4nm, p=0.004). Administration of a loop diuretic had no effect on intraplatelet levels of calcium. 1 hypothesised that this rise in intracellular calcium might be related to the severity of illness and thus correlate with the APACHE II score, an objective scoring system used to stratify patients according to prognosis. No correlation was found. Finally, indirect calorimetry is an accurate, although painstaking, method of measuring energy expenditure in the critically ill patient. Metabolic rate may be related to clinical outcome. If the resting energy expenditure (REE) correlated with the APACHE II score, the latter, simpler measurement could be used as part of a formula to predict metabolic rate. My studies of REE in patients with ARF showed no correlation with the APACHE II score which should therefore not be used to predict energy expenditure in ARE. Nor was there any association between metabolic rate and the clinical outcome of the patient.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available