[Acute renal insufficiency induced at the hospital: prospective study and prevention]

To prevent hospital-induced acute renal failure (ARF), a prospective study was carried out, consisting of the recording of all cass of ARF in the hospital for a two month period (phase one). Their causes, evolution, prognostic indicators and the potentially preventable iatrogenic factors were recorded. On the basis of these data, several preventive measures were instituted (phase two) during 6 months; subsequently, during an additional 2 month period, the incidence of ARF was evaluated with the same methodology as in phase one. The number of evaluated individuals at risk (patients admitted to the hospital during the phases one and three) was 1470 and 1232, respectively. The number of recorded ARF episodes was 23 (1.6%) and 8 (0.65%) during the two periods, respectively. This reduction after the institution of preventive measures was statistically significant (p less than 0.04), with a complete disappearance of aminoglycosides as etiological factor, and a practical disappearance of multifactorial etiology, where risk diseases and drugs were also implicated. Iatrogenic factors were reduced from 75% (phase one) to 25% (phase three). The mortality rate of these patients was about 50% in both periods, and the only identified unfavorable prognostic factor was oliguria associated with ARF. It is concluded that the number of episodes of ARF, their preventable etiology and iatrogenic factors can be reduced by several prevention measures. It is advisable to implement these controls in a periodic fashion and to create surveillance committees of ARF in the hospital.