Because of their precarious hemodynamic state, with prolonged drop in blood pressure, it is common for patients admitted to resuscitation to have a brutal aggravation of their kidney function. This acute renal failure, most often due to tubular necrosis, is associated with a much more reserved prognosis when it occurs in patients in resuscitation. Patients who evolve favorably during their stay in resuscitation will however, mostly completely recover their kidney function. This having normalized, these patients generally do not benefit from any nephrological monitoring when they come out of resuscitation.
“However, an episode of acute renal failure is not trivial. Even if they have recovered in the short term, it has been established for ten years now in the long term now, these patients are at risk of developing a chronic kidney disease. This is the reason why we have set up at the Center for Nephrology of Design, in collaboration with all the resuscitation of the AP-HM, a consultation dedicated to these patients. »» (Dr Mickael Bobot)
Whether they needed dialysis or not, patients who have developed severe renal failure during their resuscitation stay are now systematic reviewed 3 months later in consultation at the Center of Nephrology and Renal Transplantation of Pr Philippe Brunet. A standardized assessment is carried out to detect possible alterations of the renal function or anomalies such as proteins or blood in the urine, or even high blood pressure. The objective is to be able, early, to detect the occurrence of a chronic sector renal disease and prevent its aggravation thanks to nephroprotective treatments and appropriate hygienic measures * .
“Of the first 50 patients in our cohort, 58 % of them had a chronic kidney disease at 3 months. In 51 %, the consultation made it possible that these patients benefit from the prescription of a nephroprotective treatment indicated at this stage of the development of the disease. The personalized monitoring that we put in place later depends on the evolution of the disease and the risk factors such as diabetes, hypertension or age. The balance sheets are sent to resuscitation teams and transmitted to treating physicians. »»
Ultimately, this follow -up sector will also make it possible to better identify patients whose renal function is likely to deteriorate after acute renal failure and those which on the contrary have little risk.
“This type of specialized and systematic follow -up, involving close collaboration with resuscitators, is still very little offered in other centers, whether in France or in the world. Another interest in the consultation is that it also made it possible to detect patients who had chronic renal failure pre -existing to their stay in resuscitation. This concerned 24 % of patients, almost 1 in 4 patients. “
* For example: adapted physical activity at least 30 minutes per day, limitation of salt and protein intake, in particular animal. Control of blood sugar and blood pressure.
