| Objective: To investigate the etiology ,clinical features of acute renal failure and clinical features of acute renal failure in the elderly. we hope it may be a foundation for early management.Methods: 288 acute renal failure patients in our hospital from Jan, 1990~Aug, 2004 were analyzed retrospectively according to the etiology of pre-renal ARF, renal parenchymal , post-renal ARF . It was emphasis analyzed about pathology and clinic of renal parenchymal ARF, Etiology, clinical manifestation, prognosis, cause of death of acute renal failure in the elderly.Results: (1) They were 179 males and 109 females with mean age (47.6 ± 17.1) years old.The patterns of ARF were pre-renal ARF(19.8%), renal parenchymal ARF(70.5%), post-renal ARF (9.7%) . 57 cases with pre-renal ARF consisted of gastrointestinal fluid loss , heart failure , nephritic syndrome , post-opration ischemia. 203 cases were renal parenchymal with 85 cases (41.9%) confirmed to be ARF development from pre-renal factors. 164 cases were tubulointerstitial injures cause by drugs, infection, shock, epidemic hemorrhagic fever and rhabdomyolysis. Drug-induced ARF were 44 cases (15.3%) . 28 cases post-renal ARF resulted from tumors, stones, benign prostatic hypertrophy ,fibrosis of post-peritoneal ,malformation and neurogenic bladder. (2) From 1990 to 1999 , majority cause of ARF were drugs,epidemic hemorrhagic fever and infection; Cause of ARP had changed from 2000 to 2001 . Drugs was still the first cause of renal parenchymal ARP, but RPGN was the second cause of renal parenchymal ARP. Incidence of epidemic hemorrhagic fever had markedly decreased. The difference of two age was statistically significant(PO.05, PO.05). (3) 44 cases received renal biopsy because of glomerular disease were 30 cases, acute tubular necrosis were 9 cases and interstitial nephritis were 5 cases. The most common glomerular diseases associated with ARP was crescentic glomerulonephritis , accounted for 50.0% of ARF and 73.3% of glomerular disease. Three months after renal biopsy, the percentage of complete recovery was only 38.6% in all patients and the major histologic types in this group of patients were acute interstitial nephritis and idiopathic ARP in nephrotic syndrome . There were hardly recovery in cases whose histologic lesions were crescentic glomerulonephritis and IgA nephropathy. (4) Elderly patients with ARF were 82 cases (28.5%) . Pre-renal ARP, drugs, post-renal ARP were significantly higher in the elderly compared with the non-elderly (PO.05) . In the elderly, incidence of oliguria was higher than the non-elderly (PO.05) and the period of oliguria was longer than the non-elderly(PO.05) . Incidence of chronic disease was significantly higher in the elderly compared with the non-elderly(PO.05 ).Complications such as MODS, hyperkalemia, infection, respiratory failure, heart failure were more prevalent in the elderly compared with the non-elderly (PO.05). The mortality rate of ARF in the elderly was 31.7%. there was significantly higher than the non-elderly 19.9% (PO.05) .The main causes of the death in the elderly were MODS (30.8%) and heart failure (19.2%) . Renal function recovery delayed in the elderly compared with the non-elderly(14.6% vs 27.2%, PO.05).Conclusions: Pre-renal ARF was easy to be neglected, it wasn't diagnosis timely. Drug-induced ARP was a primary cause, although tubulointerstitial injures were still the major cause of the renal parenchymal ARP .Cause of ARF had changed followage ; Renal biopsy was very important for diagnosis, therapy, prognosis of ARF;.Elderly patients with ARF has peculiar character differ from the non-elderly.
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