Diferentes abordagens na detecção da disfunção renal aguda em pacientes graves

JUSTIFICATIVA E OBJETIVOS: As diversas definicoes para disfuncao renal aguda (DRA) tem dificultado intervencoes precoces nestes quadros, recentemente a classificacao Risk, Injury, Failure, Loss and End-stage Renal Desease (RIFLE) tem contribuido para reverter esse quadro. O objetivo deste estudo foi comparar o metodo tradicional com a classificacao RIFLE/AKIN (AcuteKidney Injury Network) para o diagnostico de DRA. METODO: Estudo retrospectivo transversal por analise de prontuariosdos pacientes internados no periodo de 15 meses, na unidadede terapia intensiva do Hospital Universitario de Alagoas.Os individuos, classificados em dois grupos (I - com lesao renal e II - sem lesao renal), foram avaliados quanto ao sexo, idade, motivo da admissao, necessidade de ventilacao mecânica e farmacos vasoativos, sepse, escore de Sepsis Occurrence in Acutely ill Patients(SOFA) e mortalidade. A avaliacao para DRA foi comparada com a registrada em prontuarios pelo medico plantonista.RESULTADOS: A ocorrencia de DRA foi de 21%, com maior gravidade e tempo de internacao neste grupo. Em relacao ao diagnostico, osplantonistas levaram o dobro do tempo para detectar DRA, utilizandoos criterios tradicionais, quando comparado ao uso do RIFLE/AKIN (p = 0,0056). Pacientes classificados com lesao e falencia pelo RIFLE foram os que apresentaram maior gravidade e pior evolucao. CONCLUSAO: A taxa de DRA encontrada foi compativel com a literatura. A escassa utilizacao da classificacao RIFLE/AKIN pelos plantonistas dificulta acoes preventivas e o tratamento da DRA, o que prejudica a evolucao e o prognostico dos pacientes,sendo necessaria maior atencao destes medicos. (AU) BACKGROUND AND OBJETIVES: The various definitions for acute kidney injury (AKI) have hampered early intervention in these clinical conditions, recently the Risk, Injury, Failure, Loss and End-stage Renal Disease (RIFLE) classification has helped to reverse this. Our study aimed to compare the traditional method with RIFLE/AKIN (Acute Kidney Injury Network) classification for the diagnosis of AKI. METHOD: Retrospective cross-section studies by medical records analysis of patients admitted within 15 months in the intensive care unit of University Hospital of Alagoas. Individuals were classified into two groups (I - with renal injury and II - without renal injury); they were evaluated for sex, age, admission reason, mechanical ventilation need and vasoactive drugs, sepsis, Sepsis Occurrence in Acutely ill Patients (SOFA) score and mortality. Our assessment for AKI was compared with that recorded in medical records by the doctor on duty.RESULTS: The occurrence of AKI was 21%, with greater severity and duration of hospitalization in this group. Regarding diagnosis, doctor on duty took twice as long to detect AKI using the traditional criteria, when compared to the use of RIFLE/AKIN (p = 0.0056). Patients classified with injury and failure, by RIFLE, were those with greater severity and worse outcome. CONCLUSION: The rate of AKI has been found compatible to the literature. The little use of the RIFLE/AKIN classification, by doctors, hampers preventive actions and treatment of AKI that affect the evolution and prognosis, requiring more attention these doctors. (AU)