The Incidence and Clinical Course of Acute Renal Failure in Patients with Severe Acute Pancreatitis

Korean Journal of Nephrology 2009;28(5):424-432.

Su Lim Lee, M.D.1, Hyun Gyung Kim, M.D.2, Byung Soo Kim, M.D.2, Ho Cheol Song, M.D.2, Bong Koo Kang, M.D.2, Hyuk Min Kwon, M.D.2, Eui Sung Chung, M.D.2, Hye Eun Yoon, M.D.2, Young Soo Kim, M.D.2, Sung Soo Kim, M.D.2, Sun Ae Yoon, M.D.2, Min-Gul Kim, M.D.3

Department of Radiology¹
Internal Medicine²
College of Medicine, The Catholic University of Korea, Seoul, Korea, Department of Pharmacology, College of Medicine, Chonbuk University³
Jeonju, Korea

임상연구 : 급중증 급성췌장염 환자에서 급성신부전증의 발생빈도와 임상경과에 대한 연구

이수림1, 김현경2, 김병수2, 송호철2, 강봉구2, 권혁민2, 정의성2, 윤혜은2, 김영수2, 김성수2, 윤선애2, 김민걸3, 김영옥2

가톨릭대학교 의과대학 방사선과학교실1, 내과학교실2, 전북대학교 의과대학 약리학교실3

Abstract

Purpose:Although acute renal failure (ARF) commonly develops in patients with severe acute pancreatitis (SAP), the impact of ARF on disease severity is rarely reported in Korea. This study was performed to compare the clinical findings, morbidity and mortality between SAP patients with and without ARF. Methods:We retrospectively evaluated the medical records of 102 patients with SAP between january 2001 and June 2008 in 3 hospitals. We investigated the incidence and clinical course of ARF in SAP patients. Then, we compared morbidity and mortality between the patients with ARF and normal renal function (NRF). Results:Of the total 102 SAP patients, ARF was observed in 39 patients (38.2%). The peak serum creatinine level in ARF patients was 4.5±2.3 mg/dL. Eight of the 39 ARF patients (20.5%) received hemodialysis and ten patients (25.6%) died. When compared to NRF patiens, ARF patients (n=39) had higher incidence of dyspnea (17.9% vs 3.2%, p=0.011), loss of consciousness (17.9% vs 1.6%, p=0.003), and APACHE II scores more than 8 (92.3% vs 0%, p<0.001). The ARF group had also higher incidences of sepsis (35.9% vs 7.9%, p<0.001), multiorgan failure (15.4% vs 0%, p=0.001), respiratory failure (28.2% vs 4.7%, p=0.001) and mortality (25.6% vs 3.2%, p=0.001). Multivariate analysis demonstrated thrombocytopenia, hemoconcentration, and high LDH as independent risk factors of ARF in SAP patients. Conclusion:The incidence of ARF was high (38.2%) and ARF patients showed higher morbidity and mortality, compared to NRF patients. We suggest that early management of ARF should be performed for reducing the mortality in SAP patients.

Key Words: Acute renal failure, Pancreatitis