DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20181513

Incidence and etiology of acute kidney injury in children admitted to PICU using pRIFLE criteria

Javid Maqbool, Aajaz Ahmad Mir, Nisar Ahmad Bhat, Waseem Qadir Moona

Abstract


Background: Acute kidney injury is a common problem highly associated with hospitalization. Acute Kidney Injury (AKI) is associated with severe morbidity and mortality especially in children. Lack of consensus definition has been major limitation in improving outcomes. This study tries to address the need of limited data on pediatric AKI. Detection of the incidence, etiological profile and outcome of AKI is important for the initiation of preventive and therapeutic strategies, identifying patients early to avoid renal replacement therapy.

Methods: This prospective observational study was conducted in the pediatric intensive care unit (PICU) of tertiary hospital (GMC Srinagar) between January 2015 to December 2016.This is the only prospective study conducted in this hospital, all other studies conducted here and other higher centers were retrospective. Serum creatinine level was estimated on all patients on admission and alternate days till discharge from Pediatric Intensive Care Unit (PICU). Urine output was recorded. Estimated Creatinine- Clearance (eCrCL) was calculated using Schwartz formula. AKI diagnosis and staging was based on pRIFLE (pediatric RIFLE) criteria. eCrCl criteria was used to diagnose and stage AKI. Maximal stage that the patient progressed during the stay in PICU was assigned the stage for that case.

Results: Of total 500 cases, 480 cases met inclusion criteria. Of them, the incidence of AKI was 154 (32.1%). Stage ‘Risk (R)’, ‘Injury (I)’ and ‘Failure (F)’ constituted 93(60.38%), 46 (29.8%) and15 (9.74%) respectively. Maximum AKI occurred in <1 year (30.5%). Infections were commonest etiology. Amongst infections sepsis (30.5%) was most common, followed by acute gastroenteritis (20.7%) and pneumonia (16.9%). Hypotension, nephrotoxic drugs, sepsis, need for mechanical ventilation were significant (p<0.001) risk factors for AKI. Pre-renal causes constituted 68% and intrinsic renal 32%.

Conclusions: The incidence of AKI is high among critically ill children. AKI continues to be associated with adverse outcomes. pRIFLE staging system provides early identification and stratification of AKI. Infections are leading etiology of AKI in children.

 


Keywords


Acute kidney injury, pRIFLE, PICU

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References


Mehta R, Cerda J. International Society of Nephrology’s by 25 Initative for acute kidney injury: a human rights case for nephrology. The Lancet. 2015.

Susantitaphong P, Cruz DN, Cerda J, Abulfaraj M, Alqahtani F, Koulouridis I, Jaber BL. World incidence of AKI: a meta-analysis. Clinical Journal of the American Society of Nephrology. 2013 Sep 6;8(9):1482-93.

Andreoli SP. Acute kidney injury in children, Pediatr Nephrol. 2009;24:253-63.

Askenazi DJ, Feig DI, Graham NM, Hui-Stickle S, Goldstein SL. 3-5 years longitudinal follow-up of pediatric patients after acute renal failure. Kidney Int. 2006;69:184-9.

Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure: Definition, outcome measures, animal models, fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8:R204-12.

Lameire N, Biesen VW, Vanholder R. The changing epidemiology of acute renal failure. Nat Clin Pract Nephrol. 2006;2:364-77.

Cerdá J, Bagga A, Kher V, Chakravarthi RM. The contrasting characteristics of acute kidney injury in developed and developing countries. Nat Clin Pract Nephrol. 2008;4:138-53.

Cerda J, Lameire N, Pannu N, Uchino S, Wang H. Epidemiology of acute kidney inury. Clin J AM Soc Nephrol. 2008;3:881-6.

Mehta P, Sinha A, Sami A, Hari P, Kalaivani M, Gulati A, et al. Incidence of acute kidney injury in hospitalized children. Indian Pediatr. 2012;49(7):537-42.

Bowers LS, Wong ET. Kinetic serum creatinine assay II. A critical analysis and review. Clin Chem. 1980;26:555-61.

Goldstein B, Giroir B, Randolph A. International Pediatric Sepsis Consensus Conference: Definitions for sepsis and organ dysfunction in Pediatrics. Pediatr Crit Care Med. 2005;6:2-8.

Basu RK, Prasad DP, Wong H, Wheeler DS.An update and review of acute kidney injury in pediatrics. Pediatr Crit Care Med. 2011;12:339-47.

Krishnamurthy S, Mondal N, Narayanan P, Biswal N, Srinivasan S. Incidence and etiology of acute kidney injury in southern india. Indian J Pediatr. 2013;80:183-9.

Schneider J, Khemani R, Grushkin C. Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit. Crit Care Med. 2010;38:933-9.

Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007;71:1028-35.

Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: A cohort analysis. Crit Care. 2006;10:R73-82.

WF Hui, Chan W, Miu TY. Acute kidney injury in the pediatric intensive care unit: identification by modified RIFLE criteria. Hong Kong Med J. 2013;19:13-9.

De Mendonça A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M, et al. Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med. 2000;26(7):915-21.