Renal failure outcome evaluation

The terminology associated with kidney diseases has been amended and is clarified here. Previously, renal failure was divided into either acute renal failure (ARF) or chronic renal failure (CRF). These terms indicate the rate at which damage occurs rather than the mechanism by which it occurs. Landmark guidelines developed in the USA by the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) attempt to evaluate, classify, and stratify CKD (see Table 45-6). The term renal has largely been replaced by Iddney when referring to chronic disease since it is better understood by patients and nonspecialists. However, acute renal failure (ARF) remains standard nomenclature along with ESRD. 

If symptoms do not improve, the patient should be evaluated for persistent infection. There are many reasons for poor patient outcome with intraabdominal infection improper antimicrobial selection is only one. The patient maybe immunocompromised, which decreases the likelihood of successful outcome with any regimen. It is impossible for antimicrobials to compensate for a nonfunctioning immune system. There may be surgical reasons for poor patient outcome. Failure to identify all intraabdominal foci of infection or leaks from a GI anastomosis may cause continued intraabdominal infection. Even when intraabdominal infection is controlled, accompanying organ system failure, most often renal or respiratory, may lead to patient demise. 

In critically ill patients with AKI, urinary KIM-1 along with N-acetyl-[beta]-(D)-glucosaminidase activity (NAG) showed increasing trends with increasing severity of illness as assessed by Acute Physiology, Age, Chronic Health Evaluation (APACHE) II and multiple organ failure scores and could be correlated to the odds for both renal replacement therapy and hospital death, suggesting these biomarkers have some predictive ability for clinical outcomes in patients with AKI [308]. 

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