Severe head trauma and acute renal failure.

We dialyzed 6 patients who developed acute renal failure after severe head trauma. 2 patients died relatively quickly (within 2 weeks) without regaining renal function. 4 patients regained renal function, but 2 died in approximately 1 month. The other 2 survived long-term in a vegetative state for 2 and 3 years, respectively. The 2 patients who died earliest had associated severe abdominal trauma and were both hemodialyzed. 3 of the 4 patients who regained renal function were peritoneally dialyzed. The 2 longest survivors had less frontal lobe involvement. Trauma followed by acute renal failure has an extremely dismal prognosis, and the head-traumatized patient carries the worst prognosis of this group. Peritoneal dialysis, preferably the new method of slow continuous peritoneal dialysis, is probably the best method of treating these patients. The decision whether to treat at all should be made early in the course based on clinical neurological criteria, ignoring the renal failure as a predictor of outcome.