The Pattern of Acute Renal Failure in Ilorin, Nigeria

Objectives: Acute renal failure is a common cause of morbidity and mortality in Nigeria. The early detection and prompt treatment of acute insults to the kidneys may prevent renal failure which is capital intensive in its management. Majority of Nigerians cannot afford the cost of renal substitution therapy which is scarce and expensive. There is no renal replacement therapy subsidy and the National Health Insurance Scheme is yet to be implemented. These underscore the need for some form of preventive nephrology in order to reduce and possibly avoid renal failure. In line with the foregoing, a 9-year (1990-1998) retrospective appraisal of causes, management and outcome of acute renal failure (ARF) was undertaken in our centre. Methods: All the ARF patients that presented primarily to the nephrology unit or were referred to the unit from other departments of the University of Ilorin Teaching Hospital for intervention were studied. Results: A total of 86 patients (40 males and 46 females) with age range between 3 and 65 years were reviewed. About 79% of the patients were less than 40 years of age and most were females. Sixty three (75%) patients were oliguric at presentation while 23 (26.7%) were non-oliguric. Altered sensorium, vomiting, and hiccups were present in 87%, 40%, and 23% respectively. Severe anaemia that necessitated blood transfusion was present in 41 (48%). The major Aetiological factors were septicaemia (36%), severe gastroenteritis (22%), acute glomerulonephritis (9.3%); drug induced (8%) and obstructive uropathy (6%). Thirteen patients had haemodialysis with 31% mortality, 9 had peritoneal dialysis with a mortality of 67% while 58 were managed conservatively with 64% deaths. The important poor prognostic factors identified were extremes of age, severe infections, late presentation, delayed intervention therapy and underlying/concurrent medical illness. The main factors that influenced the mode of therapy were severity of ARF and financial constraint. Haemodialysis appears to be the preferred method of substitution therapy in our environment for severe ARF. An urgent need for the formation of a National preventive nephrology policy is again reemphasized. Conclusion: A significant number of the patients are under 40 years old. The major causes of renal failure in Ilorin are preventable and treatable conditions. Haemodialysis is the preferred mode of intervention. Key Words: Acute renal failure, causes, management and prognosis Orient Journal of Medicine Vol.15(1&2) 2003: 18-23