ABSTRACT
Despite vast improvements in the understanding of renal
failure in critically ill surgical patients, the incidence of acute
renal impairment requiring dialysis remains at 50-200 cases
per million population.1,2 Modest degrees of acute renal
failure (ARF) not resulting in dialysis treatment have been
reported as increasing the risk of death approximately five-
fold.3 Specific surgical conditions are related to a higher
incidence of ARF: for example, after cardiac surgery it has
been reported to be as high as 30 per cent,4 whereas abdom-
inal aortic surgery is associated with an incidence of oliguric
renal failure of 2-7 per cent and an associated mortality of
Compounding the exact incidence are imprecise defin-
itions of ARF, for example: ‘An acute and usually reversible
deterioration of renal function, which develops over a
period of days or weeks, and results in uraemia’. Although a
marked reduction in urine volume is usual it is not invari-
able, and clearly, in the surgical population, if established
acute renal failure is left untreated the patient will die. The
mortality associated with the condition in isolation is 8 per
cent; unfortunately, the patients who develop ARF while on
the critical care unit do so as a part of generalized multiple
organ failure (MOF), when the mortality increases to between
60 and 90 per cent.
