Renal Insufficiency After Trauma and Sepsis

Abstract

A prospective serial study of renal function following massive injury or sepsis was performed in 69 patients. Eleven patients developed renal failure. Renal plasma flow depression was proportional to the extent of injury and usually returned to normal within six days. Prolonged depression was associated with increased morbidity. Depression of glomerular filtration rate was associated with a high incidence of renal failure. Electron microscopy in two patients showed activated platelets and red cell aggregates obstructing interstitial capillaries in one case, and glomerular capillary obstruction by mesangial cell extrusions in another. Some patients responded to sepsis with an obligatory water loss followed by circulatory collapse and renal failure if fluid replacement was inadequate.