Renal rescue therapy in early stage of severe sepsis: a case study approach.

OBJECTIVE: The aim of this study was to evaluate the efficacy of noradrenaline and furosemide in combination for the treatment of impending acute renal failure in early stage of severe sepsis. DESIGN: observational case study. SETTING: Nine-bed general ICU in university-affiliated cancer institute. PATIENTS: Severe septic cancer patients admitted to the ICU. MEASURMENTS AND RESULTS: 17 severe septic patients with multiorgan dysfunction syndrome (admission SOFA score, mean 9.1+/-3.0 p, and APACHE II score, mean 20.4+/-5.1 p.) received full intensive treatment including volume expansion, hemodynamic support with noradrenaline infusion and low-dose hydrocortisone. Severe sepsis was documented by proven infection, site of infection and high levels of procalcitonin (mean value 69.8 ng/ml, 7.1-588 ng/ml), C-reactive protein (mean 210 mg/l, range 49-370 mg/l) and low total cholesterol levels (mean 2.36 mmol/l, range 1.3-3.9 mmol/l). Acute renal injury and acute renal failure syndrome were detected in 14 patients (82 %) out of 17. The combination of noradrenaline continuous infusion (0.06-0.12 microg/kg/min) and furosemide infusion (10-30 mg/hr) was used for hemodynamic and renal support. We induced polyuria and reverse acute tubular necrosis to nonoliguric acute renal failure in 11 patients (78.5 %) from 14 septic cancer patients with acute renal injury/failure syndrome. We recorded 35.2 % hospital mortality due to the severe sepsis and septic shock. We used no renal replacement therapy. CONCLUSION: We consider renal rescue protocol as an effective method in the treatment for acute renal injury/failure syndrome in early phase of severe sepsis, when it is instituted very early with low/moderate dosage of noradrenaline and furosemide. (Tab. 6, Ref. 29.)