SUN-017 ACUTE PANCREATITIS RELATED ACUTE KIDNEY INJURY - A SOUTHERN INDIAN SINGLE CENTER EXPERIENCE

Abstract

Acute kidney injury (AKI) is a serious complication of acute pancreatitis (AP) with overall incidence of 14 – 40 %. Data on clinical profile and outcome of AKI is sparse. Our aim was to study the clinical profile, risk factors, complications and outcome of AP as AKI. A prospective observational analysis of 55 patients referred to our institute from September 2015 to July 2019 was done. Acute pancreatitis was diagnosed by clinical history, elevated lipases/amylases > 3 times upper limit of normal and imaging. BISAPS score was used to assess the severity of acute pancreatitis. Acute kidney injury was staged by KDIGO classification. Patients were treated symptomatically and renal replacement therapy(HD/PD) was initiated for routine indications. Number of sessions of hemodialysis and outcome at discharge and prognosis on follow up were noted. A total of 55 patients presented with acute pancreatitis with AKI. Of them 54(98 %) were males with mean age of 38.24 years ± 8.87 years. Aetiology of AP was Alcohol in 48(87.2%), Drug related in 1(1.8%), IgG4 related disease in 1(1.8%) and Unidentified in 5(9.0%). Oliguria was observed in 29(52.7%), Hepatic injury in 13 (26.3%), Shock in 6(10.9%) and Respiratory failure in 5(9.1%). Patients expired were 17(30.9%). Among survivors, 25(45.5%) had complete renal recovery and 13(23.6%) progressed to chronic kidney disease. The median duration of follow up was 2.5 years. Among survivors and expired, shock(p = 0.009), respiratory failure(p =0.028), elevated aspartate transaminases(p =0.01), hypoalbuminemia{< 2.5 g/dl}(p = 0.007), BISAPS score> 3 (p = 0.001) at presentation were associated with statistically significant higher risk of mortality. Among survivors, volume overload(p = 0.028), serum creatinine >5 mg/dl (p = 0.001) at admission was associated with progression to chronic kidney disease. Dialysis requiring were seen in 26(47.3%). KDIGO stage 1 in 1(1.8%), KDIGO stage 2 in 8 (14.5%), KDIGO stage 3 in 46(83.6%). Among them, higher KDIGO stage, portended poorer prognosis(p = 0.03). Four patients underwent renal biopsy, of which three had Thrombotic Microangiopathy and one had IgG4 related disease. 1.Alcohol was the commonest cause for AKI.2.AP – AKI was associated with high mortality 17(30.9%)3.23.6%(13) of patients progressed to Chronic kidney disease.