急性腎不全の予後に関する臨床的検討 第1報 : 急性腎不全の予後決定因子と予後からみた急性腎不全の分類について

Abstract

Despite recent progress on hemodialysis accomplished by the aid of modern technology, no significant improvement in survival rate of acute renal failures has achieved yet. In order to clarify the reason of unexpectedly low survival rate as mentioned above, the author analyzed the factors influencing prognosis of 51 acute renal failures who were hemodialyzed at the Yokohama City University Hospital between 1969 and 1978. Overall survival rate was 51%. Analysis on clinical data revealed that prognosis of the acute renal failures was influenced mostly by severity of underlying disorders, age of the patients and by uremic status of the patients. Because of uremic status which can be modified variously by intensive hemodialysis, other 2 definitive factors namely severity of underlying disorders and age of the patients were selected as factors which could define new criteria. In order to foretell the prognosis of acute renal failure, the author proposed new criteria namely Risk Groups. Risk I Group composed of acute renal failures whose underlying disorders are of uncomplicated medical and obstetrical origin and or uncomplicated surgical patients below 50 years of age. Risk 2 Group composed of acute renal failures of uncomplicated surgical origin above age 50. Risk 3 Group composed of all other acute renal failures with fatal complications. This new criteria of Risk Group corresponded to the prognosis very well when applied to the author's series as follows; mortality rates of Risk 1, 2 and 3 were 16.7%, 91.7% and 100%, respectively. This criteria of risk group can either foretell the fate of acute renal failures or judge the therapeutic efficacy concerning hemodialysis and related therapy.