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[Acute renal failure with lactic acidosis]
Nihon Jinzo Gakkai Shi
|June 1, 1990
Summary
Lactic acidosis in acute renal failure (ARF) is linked to severe liver issues and poor outcomes. Both lactate overproduction and underutilization contribute, with underutilization significantly impacting prognosis. Continuous renal replacement therapy with alkali may help manage this condition.
Area of Science:
- Nephrology
- Gastroenterology
- Critical Care Medicine
Context:
- Acute renal failure (ARF) presents complex acid-base disturbances.
- Lactate metabolism is a critical, yet understudied, factor in ARF pathophysiology.
- Co-existing severe hepatic failure significantly complicates ARF cases.
Purpose:
- To investigate the role of lactate metabolism in acid-base disturbances in patients with ARF.
- To analyze the correlation between lactate levels and clinical parameters in ARF.
- To evaluate the prognostic implications of lactic acidosis in ARF.
Summary:
- 18 adults with ARF were studied, with 55% developing lactic acidosis, often alongside severe hepatic failure.
- Elevated lactate, pyruvate, and L/P ratios were observed in ARF patients compared to controls.
- Lactic acidosis in ARF is attributed to both lactate overproduction and underutilization, with the latter influencing prognosis.
- High mortality (80%) was associated with lactic acidosis in ARF.
- Significant correlations were found between lactate levels and pH, HCO3-, AG, and L/P.
- Continuous venovenous hemofiltration (CAVH) combined with alkali infusion showed potential in managing lactic acidosis in ARF.
Impact:
- Highlights the critical role of lactate metabolism in ARF and its association with hepatic failure.
- Identifies lactate underutilization as a key prognostic factor in ARF-induced lactic acidosis.
- Suggests potential therapeutic strategies, including CAVH and alkali infusion, for managing this severe condition.