Spectrum of Paediatric Acute Kidney Injury - A Referral Hospital Experience In A Developing Nation

Abstract

Context: AKI in children is associated with significant morbidity and mortality in children. Aims: To evaluate the etiological profile and factors predicting outcomes in paediatric acute kidney injury (AKI) Settings and Design: Prospective observational study from December 2012- November 2014 Methods and Material: All children age 1day to 18 years of age with clinical symptoms or abnormal laboratory parameters suggesting acute kidney injury were included in the study. Demographic characteristics, clinical history and relevant investigations performed. Renal failure classified by pRIFLE. Renal biopsy was done if AKI was persisted >3weeks.Dialysis was performed when needed and outcomes are analysed.Statistical analysis used:Descriptive statistics for continuous variables. Pearson chi-square test for categorical data using Epi info TM 7 statistical software. Results: The incidence of AKI is 6.96%(122/1482).Neonates were 4.9%(6), infants were 12%(15),children 112years were53%(65) and 13-18years were29%(36). Male female ratio was 1.44(72/50). Infections were the commonest etiology in 57%(70) with highest being malaria. Glomerular diseases were seen in 30.3%(30) and were more common in 13-18years. Renal biopsy was done in 33.6%(41) and most common pathologies was acute tubular necrosis. About 48.36%(59) needed dialysis. The outcomes analysed are total recovery 71.95%(89), progression to chronic kidney disease-10.65%(13) and death in 16.39%(20). Predictors of mortality include 1-12year age group (p value 0.03), infectious etiology(p value 0.001), respiratory distress (p value 0.003), abnormal liver enzymes (p value 0.02) and positive blood c/s ( p value 0.009)