Pediatric acute kidney injury – Prevalence, clinical spectrum and outcome in a tertiary care institute of Eastern India

Abstract

In this study, we wanted to determine the incidence and prevalence of AKI in admitted patients of our institution in relation to their age, sex and clinical conditions. We also wanted to study the various aetiologies causing acute kidney injury in children, its severity in admitted patients, the time interval of onset of disease and onset of AKI, it’s mode of management and outcomes in children.This study was conducted in the paediatric ward of a tertiary care hospital in Eastern India. Total 147 cases of hospitalized AKI patients were studied.The incidence of AKI was found to be 1.27% in all hospitalized children. Maximum no. of cases were found in the age group >10 years (44.2%). Male children outnumbered female children by a ratio of 2:1. Fever (72.8%) and Oliguria/anuria (72.1%) were the most common presenting features. Pallor was the most common presenting sign in 66% followed by oedema (42.2%), encephalopathy (31.9%) and respiratory distress (16.3%). 32% of cases presented within 24hrs with an H/O oliguria/anuria and 64% in within 72hrs. Most patients were managed with conservative management (53%) but 36.7% were managed with HD and 10.3% were managed with PD.Acute Kidney Injury cases were more common in children of age group >10 years, males being affected more. Fever and oliguria/anuria were the commonest mode of presentations with malaria as the most frequent clinical condition associated with AKI followed by sepsis. The renal type was the commonest type of AKI. There was a moderate derangement of kidney function in the majority of cases with hyperkalaemia in a significant group of patients. 47% of patients required dialytic support and case fatality was 13%. The presence of dysnatremia, hyperkalaemia, encephalopathy and shock were poor predictors of the outcome of AKI.