Etiological spectrum and short term outcome of acute kidney injury in children: a prospective study

Authors

  • K. Mahesh Department of Pediatrics, Vijayanagar Institute of Medical Sciences, Cantonment, Ballari, Karnataka, India
  • Vishwanath B. Department of Pediatrics, Vijayanagar Institute of Medical Sciences, Cantonment, Ballari, Karnataka, India
  • Kalpana S. Department of Pediatrics, Vijayanagar Institute of Medical Sciences, Cantonment, Ballari, Karnataka, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20193737

Keywords:

Acute kidney injury, Children, Etiology, Mortality

Abstract

Background: Acute Kidney Injury is a common condition in critically ill children, and it is independently associated with increased mortality. Etiology of AKI in admitted patients is multi factorial. The present study was conducted to determine possible etiologies and to know short term outcome.

Methods: A prospective case series study was conducted in our PICU from Nov 2014 to October 2015. The cases fulfilling criteria as AKI, as per definition were included in study. The urine output was monitored, base line blood urea and serum creatinine was estimated at admission and on alternate days till recovery. Investigations were done to know exact etiology of prerenal, renal or post renal AKI. Cases were managed accordingly and short term outcome was noted.

Results: Out of 150 cases studied, 87(58%) were boys and 63(42%) were girls.  Ninety three cases (62%) had oliguria and remaining patients had non-oliguric AKI. Majority of cases in the study belonged to prerenal AKI, followed by renal and post renal AKI. Amongst 150 cases,136 children managed conservatively,11 cases required hemodialysis and 3 cases peritoneal dialysis. In our study, 16 cases succumbed with mortality of 10.66%.

Conclusion: AKI is common associated condition in children admitted to PICU. AKI is commonly seen with acute gastroenteritis with severe dehydration, sepsis, glomerulonephritis and dengue shock syndrome. Most of these conditions are easily preventable. Early and effective management of hypovolemic shock and sepsis is also crucial in prevention of AKI.

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References

Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Working Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2(1):1-138.

Rajasree Sreedharan, Ellis D Avner. Acute Kidney Injury. In: Kliegman, Stanton, St Geme, Schor, editors. Nelson Textbook of Pediatrics. 20th ed. Philadelphia: Elsevier; 2017:2539-2543.

Mehta RL, Cerda J, Burdmann EA, Tonelli M, Garcia-Garcia G, Jha V, et al. International Society of Nephrology's 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. The Lancet. 2015;385(9987):2616-43.

Susantitaphong P, Cruz DN, Cerda J, Abulfaraj M, Alqahtani F, Koulouridis I, et al. World incidence of AKI: a meta-analysis. Clin J Am Society Nephrol. 2013 Sep 6;8(9):1482-93.

Lameire NH, Bagga A, Cruz D, De Maeseneer J, Endre Z, Kellum JA, et al. Acute kidney injury: an increasing global concern. The Lancet. 2013 Jul 13;382(9887):170-9.

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

Zappitelli M. Epidemiology and diagnosis of acute kidney injury. Semin Nephrol. 2008; 28(5):436-46.

Lameire NH, Van Biesen W, Vanholder R. The changing epidemiology of acute renal failure. Nat Clin Pract Nephrol. 2006;2(7):364-77.

Cerda 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(3):138-53.

Cerda J, Lameire N, Pannu N, Uchino S, Wang H. Bagga A, et.al. Epidemiology of acute kidney injury. Clin J Am Soc Nephrol. 2008;3:881-6.

Arikan AA, Williams EA, Graf JM, Kennedy CE, Patel B, Cruz AT. Resuscitation Bundle in pediatric shock decreases acute kidney injury and improves outcomes. J Pediatr. 2015;167(6):1301-5.

Krishnamurthy S, Mondal N, Narayanan P, Biswal N, Srinivasan S, Soundravally R. Incidence and etiology of acute kidney injury in southern India. Ind J Pediatr. 2013;80:796-9.

Freire KMS, Bresolin NL, Farah ACF, Carvalho FLC, Goes JEC. Acute kidney injury in children: Incidence and prognostic factors in critically ill patients. Rev Bras Ter Intensive. 2010;22(2):166-74.

Srinivasa S, Reshmavathi V. Incidence and etiology of acute kidney injury in children admitted to PICU using pRIFLE criteria. Curr Pediatr Res. 2016:20:1-6.

Bresolin N, Silva C, Halllal A. Prognosis for children with acute kidney injury in the intensive care unit. Pediatr Nephrol. 2009;24:537-44.

Krishnamurthy S, Narayanan P, Prabha S. Clinical profile of acute kidney injury in a pediatric intensive care unit from Southern India: A prospective observational study. Indian J Crit Care Med. 2013;17(4):207-13.

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(3):73.

Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007;71(10):1028-35.

Tresa V, Yaseen A, Lanewala AA, Hashmi S, Khatri S, Ali I, et al. Etiology, clinical profile and short term outcome of acute kidney injury in children at a tertiary care pediatric nephrology centre in Pakistan. Renal Failure. 2017;39:26-31.

Cao Y, Yi ZW, Zhang H, Dang X, Wu XC, Huang AW. Etiology and outcomes of acute kidney injury in Chinese children: A Prospective multicentre investigation. BMC Urol. 2013;13(1):1-8.

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Published

2019-08-23

How to Cite

Mahesh, K., B., V., & S., K. (2019). Etiological spectrum and short term outcome of acute kidney injury in children: a prospective study. International Journal of Contemporary Pediatrics, 6(5), 2121–2124. https://doi.org/10.18203/2349-3291.ijcp20193737

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Original Research Articles