Abstract
Background and Objective:Tetanus is a potentially fatal but preventable disease. Mortality is related to severity of the disease, cardiovascular, pulmonary and renal complications. Acute kidney injury (AKI) is a frequent and lethal complication of tetanus. The objective was to determine the frequency of AKI in tetanus patients managed in a public hospital.Methods:Children aged 1-12 years admitted in Paediatric Intensive Care Unit (PICU) with the clinical diagnosis of tetanus over three and half years were recruited for the retrospective study. pRIFLE (Pediatric Risk, Injury, Failure, Loss, End) criteria was applied to all cases of tetanus to categorize them as having AKI or not, on the basis of estimated creatinine clearance (ECCL). Comparison was done between AKI and non-AKI cases, as well as between AKI survivors and AKI non-survivors. The study was conducted at PICU of Dr. Ruth K.M. PFau Civil Hospital Karachi for tetanus cases admitted during July 2013 to December 2016Results:During the study period, 44 patients of tetanus were enrolled. Nearly 32 % of tetanus patients developed acute renal dysfunction according to PRIFLE criteria. There were overall 15 (34.09%) expiries among tetanus patients among which nine (60%) had AKI. Oliguria was observed in five (35.71%) cases. All the AKI non-survivors had ECCL below 50% and all had autonomic instability. AKI developed towards the end of first week in three cases, mid of second week in four cases and third week in seven cases. Renal replacement therapy (RRT) i.e. peritoneal dialysis (PD) was done in four AKI cases but it did not improve the outcome. CRP was more than 50 in 24 (54.54%) cases. Ventilatory support was given to 85.71% with AKI as compared to 66.66% of non AKI patients.Conclusion:Development of AKI in tetanus is multifactorial. Major contributors are severity of the tetanus itself, presence of autonomic instability, ventilator dependency, and sepsis. Presence of AKI worsens the outcome of tetanus in terms of survival, length of stay, hospital cost and ventilator days.
Highlights
Among hundreds of infectious diseases known today, tetanus is a potentially fatal disease, which still remains an important public health problem in developing countries[1], which requires continuous and strong efforts of both public and private sectors for the eradication
This study was carried out to find the frequency of Acute kidney injury (AKI) in tetanus patients managed in a public hospital in Karachi
Children aged one month to twelve years admitted in Paediatric Intensive Care Unit (PICU) with the clinical diagnosis of tetanus over past three and half years i.e. from July 2013 to December 2016 were recruited for the study
Summary
Among hundreds of infectious diseases known today, tetanus is a potentially fatal disease, which still remains an important public health problem in developing countries[1], which requires continuous and strong efforts of both public and private sectors for the eradication. The current burden of tetanus in Pakistan is alarming like other vaccine preventable diseases the exact figures. Various factors have been related to high mortality rates seen in tetanus like grade of severity of the disease itself and development of cardiovascular, pulmonary and renal complications.[8]. Acute kidney injury (AKI) is a frequent and lethal complication of tetanus.[9] A recent multivariate analysis of 236 ICU tetanus patients disclosed a direct association between AKI and tetanus mortality.[10] This study was carried out to find the frequency of AKI in tetanus patients managed in a public hospital in Karachi, (to prevent AKI in future, in such cases)
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