Epidemiology and outcome of acute kidney injury in hospitalized children: experience from a tertiary care hospital in Eastern India
DOI:
https://doi.org/10.18203/2349-3291.ijcp20232878Keywords:
Acute kidney injury, Hospitalized children, AKINAbstract
Background: The aim of the study was to assess the etiology, clinical profile and short-term outcome of acute kidney injury in hospitalized children.
Methods: A single centre prospective observational study conducted at a tertiary care hospital in eastern India. Consecutive hospitalized children aged between one month to twelve years who developed AKI according to AKIN criteria were included in the study. Relevant clinical and laboratory parameters as guide by clinical condition along with outcome of patients were recorded at the time of discharge and at one month and three months after discharge.
Results: 116 hospitalized children who developed AKI were included in the study; 63 (54.3%) participants are above 5 years of age with male to female ratio of the study population was 1.07:1. Infections (46.5%), acute glomerulonephritis (19.8%), snake bite (11.2%) and post-surgery (8.6%) were the common causes of AKI. 43.1% of them had AKIN stage 3. 66.4% had oliguria, 33.6% had shock. 72.4% required admission at Pediatric Intensive Care Unit support, 32.4% required ionotrop support, 44.8% required mechaicanical ventilator support. Around 65% requrired dialysis support; of which 75% recieved hemodialysis and 25% requied peritoneal hemodialysis. Mortality rate was 44%. At discharge, 41.6% (n=27) of the patients had complete renal recovery from AKI. Percentage of partial renal recovery at the time of discharge, 1 month and 3 months after discharge were respectively 53.8%; 47.7% and 10%. 3 patients at the time of discharge and 2 patients after 3 months required persistent dialysis support. Number of factors are associated with poor outcome especially higher acute kidney injury state, critically ill patients and low serum albumin at admission.
Conclusions: Infection is the leading cause of acute kidney injury in hospitalized children in this part of world. Mortality in critically ill children with acute kidney injury is high. Various clinical parameters at presentation are associated with poor short term renal outcome.
References
Jetton JG, Askenazi DJ. Acute kidney injury in the neonate. Clin Perinatol. 2014;41(3):487-502.
Alkandari O, Eddington KA, Hyder A, Gauvin F, Ducruet T, Gottesman R, et al. Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: a two-center retrospective cohort study. Crit Care. 2011;15(3):R146.
Williams DM, Sreedhar SS, Mickell JJ, Chan JC. Acute kidney failure: a pediatric experience over 20 years. Arch Pediatr Adolesc Med. 2002;156(9):893-900.
Sutherland SM, Ji J, Sheikhi FH, Widen E, Tian L, Alexander SR, et al. AKI in hospitalized children: epidemiology and clinical associations in a national cohort. Clin J Am Soc Nephrol. 2013;8(10):1661-9.
Basalely A, Gurusinghe S, Schneider J, Shah SS, Siegel LB, Pollack G, et al. Acute kidney injury in pediatric patients hospitalized with acute COVID-19 and multisystem inflammatory syndrome in children associated with COVID-19. Kidney Int. 2021;100(1):138-45.
Askenazi DJ, Feig DI, Graham NM, Hui-Stickle S, Goldstein SL. 3-5 year longitudinal follow-up of pediatric patients after acute renal failure. Kidney Int. 2006;69(1):184-9.
Mammen C, Al Abbas A, Skippen P, Nadel H, Levine D, Collet JP, et al. Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit: a prospective cohort study. Am J Kidney Dis. 2012;59(4):523-30.
Goldstein B, Giroir B, Randolph A, International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6(1):2-8.
Ceriotti F, Boyd JC, Klein G, Henny J, Queraltó J, Kairisto V, et al. Reference intervals for serum creatinine concentrations: assessment of available data for global application. Clin Chem. 2008;54(3):559-66.
Devarajan P. Update on mechanisms of ischemic acute kidney injury. J Am Soc Nephrol. 2006;17(6):1503-20.
Rabb H. Immune modulation of acute kidney injury. J Am Soc Nephrol. 2006;17(3):604-6.
Venkatachalam MA, Weinberg JM, Kriz W, Bidani AK. Failed Tubule Recovery, AKI-CKD Transition, and Kidney Disease Progression. J Am Soc Nephrol. 2015;26(8):1765-76.
Hostetter TH, Olson JL, Rennke HG, Venkatachalam MA, Brenner BM. Hyperfiltration in remnant nephrons: a potentially adverse response to renal ablation. Am J Physiol. 1981;241(1):F85-93.
Helal I, Fick-Brosnahan GM, Reed-Gitomer B, Schrier RW. Glomerular hyperfiltration: definitions, mechanisms and clinical implications. Nat Rev Nephrol. 2012 Feb 21;8(5):293-300.
Basile DP, Donohoe D, Roethe K, Osborn JL. Renal ischemic injury results in permanent damage to peritubular capillaries and influences long-term function. Am J Physiol Renal Physiol. 2001;281(5):F887-99.
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.
Nawaz S, Afzal K. Pediatric acute kidney injury in North India: A prospective hospital-based study. Saudi J Kidney Dis Transpl. 2018;29(3):689-97.
Krishnamurthy S, Mondal N, Narayanan P, Biswal N, Srinivasan S, Soundravally R. Incidence and etiology of acute kidney injury in southern India. Indian J Pediatr. 2013;80(3):183-9.
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 center in Pakistan. Ren Fail. 2017;39(1):26-31.
Bai S, Moorani KN, Naeem B, Ashfaq M, Rajesh, Rehman EU. Etiology, Clinical Profile, and Short-Term Outcome of Children With Acute Kidney Injury. Cureus. 2022;14(2):e22563.
Rao BN, Rathia SK, Phuljhele S, Verma YK, Amle D. Incidence, risk factors, clinical profile, and determinants (affecting outcome) of new onset acute kidney injury developing in critically Ill patients in pediatric intensive care unit of a tertiary hospital in middle India. Int J Pediatr Res. 2019;6(05):252-61.
Jan M, Ashraf M, Baba RA, Bhat SA. Risk factors and occurrence of chronic kidney disease following acute kidney injury in Children. Ann Afr Med. 2022;21(4):366-70.
