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Abstract
RÉSUMÉ
INTRODUCTION. Les études sur l’insuffisance rénale aigue (IRA) au cours de l’acidocétose diabétique (ACD) sont rares. Notre but était de décrire le profil épidémiologique, évolutif ainsi que la prise en charge de l’IRA-ACD en milieu de réanimation.
MÉTHODOLOGIE. Il s’agit d’une étude rétrospective menée sur une série de patients hospitalisés de Janvier à Juillet 2012 dans le service de réanimation médicale du CHU Ibn Rochd de Casablanca pour acidocétose diabétique. L’IRA a été définie en utilisant les critères de classification RIFLE (Risk Injury Failure Loss End stage).
RÉSULTATS. La prévalence de l’IRA à l’admission chez les 25 patients hospitalisés pour acidocétose diabétique était de 44%, soit 11 patients. L’âge moyen était de 45 ans (écart type : 16,6) et il y avait 7 femmes (64%). 7 patients (64%) étaient diabétiques connus et 5 (45%) étaient hypertendus connus. Selon le degré d’atteinte de la fonction rénale, 5(45%) étaient classés au stade «R» (baisse du DFG entre 25 et 50%), 4 (36,4%) étaient classés au stade «I» (baisse du DFG comprise entre 50 et 75%), et 2 (18,2%) étaient au stade «F» (baisse du DFG supérieure à 75%). les tableau cliniques les plus fréquents étaient le syndrome infectieux, l’hypertension artérielle, la dyspnée et la déshydratation. La glycémie moyenne était de 26,1±8,9 mmol/l, la glycosurie moyenne de 2,9± 0,7 croix, la cétonurie moyenne de 2,3±0,8 croix. Un seul patient a bénéficié d’une épuration extrarénale pour hyperkaliémie. La durée moyenne d’hospitalisation était de 6±4,5 jours. L’évolution a été favorable pour 9 cas (82%°. Aucun décès n’avait été noté.
CONCLUSION. L’IRA est fréquente au cours de l’ACD. Il faut mener des études complémentaires e en vue de la mise en oeuvre de stratégies préventives.
ABSTRACT
INTRODUCTION. The aim of our study was to describe epidemiology, evolution and take care of the Acute Renal Failure (ARF) during diabetic ketoacidosis in intensive care.
METHODOLOGY. This was a retrospective study on 6 months (January to July 2012) conduced in the medical intensive care unit of the University Hospital Ibn Rochd of Casablanca. Were included patients admitted for diabetic ketoacidosis. The ARF was defined using RIFLE criteria (Risk Injury Loss Failure End stage).
RESULTS. Of 25 patients hospitalized for diabetic ketoacidosis, 11 or 44% had ARF. Of these 45.4% were classified stage "R" (risk), 36.4% stage "I"(injury), and 18.2% stage "F"(failure). The mean age was 45 ± 16.6 years. Personal history of diabetes was found in 63.6 %. The main clinical findings on admission were: infectious syndrome 45.4%, hypertension, dyspnea and dehydration. The average blood glucose was 26.1 ± 8.9 mmol / l; glycosuria 2.9 ± 0.7 cross, ketonuria 2.3 ± 0.8 cross. One patient needed hemodialysis for hyperkalemia. The average hospital stay was 6 ± 4.5 days. The outcome was favorable in 82 % of cases... No deaths was recorded
CONCLUSION. ARF during diabetic ketoacidosis seems common. It is important to conduct additional prospective studies to better identify this disease entity for the implementation of preventive strategies.
Article Details
References
- De Mendonca A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M, Takala J, Sprung C, Cantraine F: Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med. 2000 Jul; 26(7):915-21.
- Kolhe NV, Stevens PE, Crowe AV, Lipkin GW, Harrison DA: Case mix, outcome and activity for patients with severe acute kidney injury during the first 24 hours after admission to an adult, general critical care unit: application of predictive models from a secondary analysis of the ICNARC Case Mix Programme Database. Critical Care 2008;12:S2.
- Ostermannw M, Chang R: Riyadh ICU Program Users Group Crit Care. Correlation between the AKI classification and outcome. Crit Care. 2008;12 (6):R144.
- Cole L, Bellomo R, Silvester W, Reeves JH: A prospective, multicenter study of the epidemiology, management, and outcome of severe acute renal failure in a ‘closed’ ICU system. Am J Respir Crit Care Med 2000;162: 191-196.
- Coca SG: Acute kidney injury in elderly persons. Am J Kidney Dis 2010; 56:122-31.
- Hoste EA, Kellum JA: Incidence, classification, and outcomes of acute kidney injury. Contrib Nephrol 2007; 156:32-8.
- Ali T, Khan I, Simpson W, Prescott G, Townend J, Smith W, Macleod A: Incidence and outcomes in acute kidney injury: a comprehensive population-based study. J Am Soc Nephrol 2007; 18:1292-8.
- Thakar CV, Christianson A, Freyberg R, Almenoff P, Render ML: Incidence and outcomes of acute kidney injury in intensive care units: a Veterans Administration study. Crit Care Med 2009; 37:2552-8.
- Rhita BN, Moncif MK, Abdelhalim M, Amine AZ. Epidemiology of Acute Kidney Injury in Moroccan Medical Intensive Care Patients: A Regional Prospective, Observational Study, Science Journal of Public Health. Vol. 2, No. 1, 2014; pp. 1-6
- Medve L, Csaba A, Paloczi B, Kocsi S, Gartner B, Marjanek Z et al. Epidemiology of acute kidney injury in Hungarian intensive care units: a multicenter, prospective, observational study. BMC Nephrology 2011;12:43.
- - Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C. An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med 2006; 34:1913–7.
- - Kaufman J, Dhakal M, Patel B, Hamburger R Community acquired acute renal failure. AmJ Kidney Dis 1991; 17: 191–8.
- - Linton AL, Kennedy AC. Diabetic Ketosis Complicated by Acute Renal Failure; Postgrad Med J 1963;39:452 36.
- - Al-Matrafi J, Vethamuthu J, Feber J Severe Acute Renal Failure in a Patient with Diabetic Ketoacidosis Saudi J Kidney Dis Transpl 2009;20(5):831-834.
- - Faisal Bukkar F, Andriana N, Ryadi Fadil RM, Widiasta A. Acute kidney injury as a severe complication of diabetic ketoacidosis in children: a case report. International Journal of Pediatric Endocrinology 2013, 2013(Suppl 1):P6.
- - Woodrow G, A.M. Brownjohn A.M, Turney J.H. Acute renal failure in patients with type 1 diabetes mellitus. Postgrad Med J. 1994 Mar;70(821):192-4.
- - Khan IH, Catto GR, Edward N, Macleod AM Acute renal failure: Factors influencing nephrology referral and outcome. QJM 1997 Dec; 90(12):781-5 .
- - Feest TG, Round A, Hamad S Incidence of severe acute renal failure in adults: Results of a community based study. BMJ. 1993 Feb 20;306(6876):481-3.
- - Hsu C-y, McCulloch CE, Fan D, Ordon˜ JD , Chertow GM, Go AS. Community-based incidence of acute renal failure. Kidney Int 2007; 72(2):208-12.
- - Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.
- - The Kidney Disease Improving Gloval Outcomes (KDIGO) Working Group.
- Definition and classification of acute kidney injury. Kidney Int 2012 ; Suppl 2 : 19-36.
References
De Mendonca A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M, Takala J, Sprung C, Cantraine F: Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med. 2000 Jul; 26(7):915-21.
Kolhe NV, Stevens PE, Crowe AV, Lipkin GW, Harrison DA: Case mix, outcome and activity for patients with severe acute kidney injury during the first 24 hours after admission to an adult, general critical care unit: application of predictive models from a secondary analysis of the ICNARC Case Mix Programme Database. Critical Care 2008;12:S2.
Ostermannw M, Chang R: Riyadh ICU Program Users Group Crit Care. Correlation between the AKI classification and outcome. Crit Care. 2008;12 (6):R144.
Cole L, Bellomo R, Silvester W, Reeves JH: A prospective, multicenter study of the epidemiology, management, and outcome of severe acute renal failure in a ‘closed’ ICU system. Am J Respir Crit Care Med 2000;162: 191-196.
Coca SG: Acute kidney injury in elderly persons. Am J Kidney Dis 2010; 56:122-31.
Hoste EA, Kellum JA: Incidence, classification, and outcomes of acute kidney injury. Contrib Nephrol 2007; 156:32-8.
Ali T, Khan I, Simpson W, Prescott G, Townend J, Smith W, Macleod A: Incidence and outcomes in acute kidney injury: a comprehensive population-based study. J Am Soc Nephrol 2007; 18:1292-8.
Thakar CV, Christianson A, Freyberg R, Almenoff P, Render ML: Incidence and outcomes of acute kidney injury in intensive care units: a Veterans Administration study. Crit Care Med 2009; 37:2552-8.
Rhita BN, Moncif MK, Abdelhalim M, Amine AZ. Epidemiology of Acute Kidney Injury in Moroccan Medical Intensive Care Patients: A Regional Prospective, Observational Study, Science Journal of Public Health. Vol. 2, No. 1, 2014; pp. 1-6
Medve L, Csaba A, Paloczi B, Kocsi S, Gartner B, Marjanek Z et al. Epidemiology of acute kidney injury in Hungarian intensive care units: a multicenter, prospective, observational study. BMC Nephrology 2011;12:43.
- Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C. An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med 2006; 34:1913–7.
- Kaufman J, Dhakal M, Patel B, Hamburger R Community acquired acute renal failure. AmJ Kidney Dis 1991; 17: 191–8.
- Linton AL, Kennedy AC. Diabetic Ketosis Complicated by Acute Renal Failure; Postgrad Med J 1963;39:452 36.
- Al-Matrafi J, Vethamuthu J, Feber J Severe Acute Renal Failure in a Patient with Diabetic Ketoacidosis Saudi J Kidney Dis Transpl 2009;20(5):831-834.
- Faisal Bukkar F, Andriana N, Ryadi Fadil RM, Widiasta A. Acute kidney injury as a severe complication of diabetic ketoacidosis in children: a case report. International Journal of Pediatric Endocrinology 2013, 2013(Suppl 1):P6.
- Woodrow G, A.M. Brownjohn A.M, Turney J.H. Acute renal failure in patients with type 1 diabetes mellitus. Postgrad Med J. 1994 Mar;70(821):192-4.
- Khan IH, Catto GR, Edward N, Macleod AM Acute renal failure: Factors influencing nephrology referral and outcome. QJM 1997 Dec; 90(12):781-5 .
- Feest TG, Round A, Hamad S Incidence of severe acute renal failure in adults: Results of a community based study. BMJ. 1993 Feb 20;306(6876):481-3.
- Hsu C-y, McCulloch CE, Fan D, Ordon˜ JD , Chertow GM, Go AS. Community-based incidence of acute renal failure. Kidney Int 2007; 72(2):208-12.
- Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.
- The Kidney Disease Improving Gloval Outcomes (KDIGO) Working Group.
Definition and classification of acute kidney injury. Kidney Int 2012 ; Suppl 2 : 19-36.