Acute kidney injury in children in Nigeria.

Abstract

To highlight the epidemiologic characteristics and therapeutic challenges of childhood acute kidney injury (AKI) in Nigeria. A review of AKI publications on Nigerian children between January 1990 and December 2012 was carried out. Mean age at presentation varied between 3.1 ± 2.6 and 6.28 ± 4 (0.05 - 16) years. Male/female ratio ranged between 1.38 and 2.5 to 1. Hospital-acquired AKI (hAKI) and community-acquired AKI (cAKI) accounted for 17.1 - 27.2% and 72.8 - 82.9% of all AKI cases, respectively. 12 - 35 new AKI cases are seen per year. A single-center study puts cAKI and hAKI incidences at 9.8 per million children population (pmcp)/year (0.46%) and 3.7 pmcp/ year (0.17%), respectively; cAKI and hAKI prevalence rates were 49.2 pmcp (2.23%) and 18.3 pmcp (0.84%), respectively. Leading causes of AKI, accounting for 80.0% of all etiologies, were nephrotoxins (29.0%), infection (20.0%), intravascular volume depletion (17.9%), and glomerular disease (13.1%). Financial constraints, late presentation, presence of ≥ 2 comorbidities, need for dialysis, non-dialysis when indicated, severe hypertension, white cell count > 15 000/mm3, and platelet count < 100 000/mm3 are significant mortality risk factors in childhood AKI in our environment. Mean all-cause mortality rate from pooled data was 50.4 ± 25.2% (range: 28.4 - 86.5%). AKI incidence and its leading causes, in Nigerian children, can be significantly reduced if attention is paid to public health education, enforcement of environmental sanitation laws, and prompt utilization of healthcare services during sickness.