Prognosis
Prognosis is good in otherwise healthy patients when the underlying insult is corrected. However, if there was pre-existing renal disease, advanced age, or if ATN has a severe presentation with prolonged anuria, the prognosis is poor and the patient may eventually require renal replacement therapy. Patients who are sick enough to require critical care have a higher mortality (79%) than those who are able to be managed without admission to the intensive care unit (37%).[5]
Long-term effects of acute kidney injury (AKI), whether recovered or not, have been described as uraemic memory. The hypothesis is that the greater long-term mortality of patients who have presented with an AKI could be related not only to the greater likelihood of presenting with chronic kidney disease, but also to the consequences of an inflammatory response, resulting in cardiac alterations, abnormal lung physiology, and endothelial dysfunction. These changes have been implicated during AKI and could result in more infections, cardiovascular morbidity, and stroke.[56]
Predictors of mortality include male sex, advanced age, comorbid illness, malignancy, oliguria, sepsis, mechanical ventilation, multi-organ failure, and high severity of illness.[5] One study reports a mortality rate of 24.5% after long-term follow-up, with a 5-year survival rate of 55%. During follow-up 4.7% of patients required chronic dialysis.[57]
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