Peritoneal dialysis in hypercatabolic acute renal failure

Leptospirosis and acute renal failure--clinical experiences and a review of the literature

About 50 cases of leptospirosis are diagnosed each year in the United Kingdom, with an overall mortality of 5%. Renal failure, in association with jaundice, is commonly held responsible for this figure. Over a period of 18 years, 6 cases of leptospirosis complicated by renal failure were treated at the Royal Air Force Renal Unit; there were 4 survivors. The 2 deaths occurred before the unit policy of daily haemodialysis and total parenteral nutrition, and were both from haemorrhagic complications. The authors believe that patients with leptospirosis and progressive renal impairment should be managed in renal units experienced in the management of the hypercatabolic patient, and that this should improve their prognosis.

Acute renal failure in burns

We present the combined experience of a burns unit and a renal dialysis unit in treating acute renal failure in burn injury patients. A total of 28 cases have been treated of whom 4 regained normal renal function. We would like to emphasize the following points which may improve the usually very poor prognosis: early diagnosis, early daily haemodialysis, adequate feeding and the early amputation of non viable limbs. A search of the literature reveals that only 11 previously reported cases of burns injury patients being successfully dialysed for acute renal failure.

The immediate care of acute renal failure

This article does not attempt to answer all the questions which might arise with the immediate management of a patient with acute renal failure but an effort has been made to lay down some guidelines and discuss some of the points of controversy. It should be remembered that the management of acute renal failure is an exercise in intensive care and that maintenance of non uraemic homeostasis is but one part in the overall management of the patient.