Common Cause Of Acute Kidney Injury Research Articles

Characteristics of and risk factors for death in elderly patients with acute kidney injury: a multicentre retrospective study in China

Purpose of the studyThe incidence of acute kidney injury (AKI) with a poor prognosis in the elderly has been increasing each year. This study aimed to investigate the clinical characteristics...

Gene-modified Mesenchymal Stem Cell-based Therapy in Renal Ischemia- Reperfusion Injury.

Acute Kidney Injury (AKI) is a common syndrome in the clinic and has become a worldwide public health problem. Renal Ischemia-Reperfusion Injury (IRI) is the most common cause of AKI. So far, effective treatment is still lacking for renal IRI, resulting in a high mortality rate of AKI. Mesenchymal Stem Cells (MSCs), considered as a promising candidate for tissue repair and regenerative medicine have aroused an increasing concern in recent years for the capacity of self-renewal and multi-lineage differentiation. MSC-based therapy has drawn wide attention for its therapeutic potential in renal IRI. The administrated MSCs can alleviate the renal IRI and improve the renal function for its anti-inflammatory, immunomodulation properties. MSCs preferentially migrate into injured sites to play the role of tissue repair. Furthermore, MSCs can modify the microenvironment to promote the recovery of damaged renal tubular cells via paracrine factors. However, the poor kidney-directional homing and poor survival under ischemia environment have limited their beneficial effects. Genetic modification is an effective approach to increase the therapeutic action of MSCs. MSCs are modified with exogenous genes to enhance their innate properties. Here we review the current knowledge of gene-modified MSCs, their biological characteristics and applications in renal IRI.

Predictors of Mortality in Acute Kidney Injury Patients Admitted to Medicine Intensive Care Unit in a Rural Tertiary Care Hospital.

Background:Acute kidney injury (AKI) is a challenging problem faced by intensive care clinicians worldwide, and it is associated with high morbidity and mortality, especially in critically ill patients.Materials and Methods:A hospital-based prospective, observational study was conducted in patients of AKI admitted to the Intensive Care Unit (ICU) of the Department of Medicine in a rural tertiary care hospital located in central India. Data of all consecutive AKI inpatients related to demographic variables, clinical profile, and laboratory investigations were collected from patient's medical records.Results:Of the total 229 AKI patients enrolled in this study, 65 (28.4%) patients died during their hospital stay. The presence of metabolic acidosis, hypotension, Glasgow coma scale (GCS) and Acute Physiologic Assesment and Chronic Health Evaluation (APACHE 2) score, advanced AKI stage, higher serum creatinine and blood urea levels on diagnosis of AKI and the peak rise in their level within 48 h of diagnosis of AKI, the use of mechanical ventilator, leukocytosis, and hyperkalemia were significantly associated with in-hospital mortality in AKI patients (P < 0.05).Conclusion:The overall in-hospital mortality in patients of AKI admitted to medicine-ICU was 28.4%. Sepsis was the most common cause of AKI (24.5%). The presence of metabolic acidosis, hypotension, GCS and APACHE 2 score, advanced AKI stage, higher serum creatinine, and blood urea levels on diagnosis of AKI and the peak rise in their level within 48 h of diagnosis of AKI, use of mechanical ventilator, leukocytosis, and hyperkalemia were associated with in-hospital mortality in AKI patients.

Combination of Mean Platelet Volume/Platelet Count Ratio and the APACHE II Score Better Predicts the Short-Term Outcome in Patients with Acute Kidney Injury Receiving Continuous Renal Replacement Therapy

Background/Aims: Both the Acute physiology and Chronic Health Evaluation (APACHE II) score and mean platelet volume/platelet count Ratio (MPR) can independently predict adverse outcomes in critically ill patients. This study was aimed to investigate whether the combination of them could have a better performance in predicting prognosis of patients with acute kidney injury (AKI) who received continuous renal replacement therapy (CRRT). Methods: Two hundred twenty-three patients with AKI who underwent CRRT between January 2009 and December 2014 in a Chinese university hospital were enrolled. They were divided into survivals group and non-survivals group based on the situation at discharge. Receiver Operating Characteristic (ROC) curve was used for MPR and APACHE II score, and to determine the optimal cut-off value of MPR for in-hospital mortality. Factors associated with mortality were identified by univariate and multivariate logistic regression analysis. Results: The mean age of the patients was 61.4 years, and the overall in-hospital mortality was 48.4%. Acute cardiorenal syndrome (ACRS) was the most common cause of AKI. The optimal cut-off value of MPR for mortality was 0.099 with an area under the ROC curve (AUC) of 0.636. The AUC increased to 0.851 with the addition of the APACHE II score. The mortality of patients with of MPR > 0.099 was 56.4%, which was significantly higher than that of the control group with of ≤ 0.099 (39.6%, P= 0.012). Logistic regression analysis showed that average number of organ failure (OR = 2.372), APACHE II score (OR = 1.187), age (OR = 1.028) and vasopressors administration (OR = 38.130) were significantly associated with poor prognosis. Conclusion: Severity of illness was significantly associated with prognosis of patients with AKI. The combination of MPR and APACHE II score may be helpful in predicting the short-term outcome of AKI.

Epidemiology and outcome of acute kidney injury from a tertiary care hospital in India.

We aimed to study the epidemiology and outcome of acute kidney injury (AKI). This is a prospective study of adults aged 18 years or above diagnosed with AKI over a period of 16 months at a tertiary care hospital. Three hundred and nine patients had AKI. The observed incidence of AKI was eight per 1000 admissions. About 92.2% had community-acquired AKI (CA-AKI), and in 7.8% it was hospital-acquired AKI (HA-AKI). Etiological factors for AKI were medical in 87.4% of the cases, surgical in 9.4%, and obstetric 3.2%. Sepsis was the most common (53.1%) etiology of AKI among the medical cases. Among sepsis, scrub typhus, urosepsis, and pneumonia were the most common causes of AKI. Hypovolemia (9.4%), biological toxins (8.4%), nephrotoxic drugs and chemicals (7.4%), cardiac causes (7.4%), and acute glomerulonephritis (1.9%) were other medical causes of AKI. Nearly 38.2% had multiorgan failure, 20.1% required vasopressors, 6.1 % required Intensive Care Unit support, and 23.3% required dialysis. Mortality was 8.7%. Anemia, use of vasopressor drugs, and need for intensive care support were independent predictive factors for mortality. AKI is common in hospitalized adults in India and leads to significant in-hospital mortality. AKI is largely a CA-AKI and the lesser percentage is due to HA-AKI. Many causes are potentially preventable. Early fluid resuscitation, effective anti-infective treatment, appropriate antidotes, and timely referral of established AKI patients to centers with dialysis facilities can improve AKI outcomes.

Mortality risk factors in intensive care unit patients with acute kidney injury requiring renal replacement therapy: a retrospective cohort study

Mortality of critically-ill patients with acute kidney injury (AKI) requiring renal replacement therapy (RRT) in an intensive-care setting continues to remain high. There is still uncertainty as to which factors should guide clinical judgement. A cohort of 155 patients admitted to an intensive-care unit and necessitating RRT due to AKI were retrospectively analyzed. Demographic and clinical parameters at the time of RRT initiation were retrieved. Multi- and univariate analyses were performed to determine the impact of different risk factors on mortality. The most common causes of AKI were sepsis (39.3%) and cardiac events (32%). The majority of patients were treated by continuous (67.3%), the others by intermittent RRT. After 30 days, 51.0% of patients survived. Nonsurvivors were older (73 vs. 69 years), had a higher APACHEE II score (30.1±5.6 vs. 26.5±7.1), and were more likely to be vasopressor dependent, mechanically ventilated, or treated by continuous RRT. Multivariate analysis revealed that higher age, higher APACHEE II score, and lower serum creatinine at baseline were independent predictors for mortality, whereas histories of diabetes mellitus, arterial hypertension, coronary heart disease, or stroke were not. Critically-ill patients with AKI requiring RRT continue to have a high mortality. Age and APACHE II score showed an impact on mortality whereas traditional cardiovascular risk factors did not. Higher BUN and creatinine levels do not have a negative impact on mortality. Our findings support the current practice that RRT initiation should primarily be guided by clinical decision. .

Renal dysfunction in cirrhosis: acute kidney injury and the hepatorenal syndrome.

Renal dysfunction is a common complication of liver cirrhosis and of utmost clinical and prognostic relevance. Patients with cirrhosis are more prone to developing acute kidney injury (AKI) than the non-cirrhotic population. Pre-renal AKI, the hepatorenal syndrome type of AKI (HRS-AKI, formerly known as ‘type 1’) and acute tubular necrosis represent the most common causes of AKI in cirrhosis. Correct differentiation is imperative, as treatment differs substantially. While pre-renal AKI usually responds well to plasma volume expansion, HRS-AKI and ATN require different specific approaches and are associated with substantial mortality. Several paradigms, such as the threshold of 2.5 mg/dL for diagnosis of HRS-AKI, have recently been abolished and novel urinary biomarkers are being investigated in order to facilitate early and correct diagnosis and treatment of HRS-AKI and other forms of AKI in patients with cirrhosis. This review summarizes the current diagnostic criteria, as well as pathophysiologic and therapeutic concepts for AKI and HRS-AKI in cirrhosis.

The risk factors and outcome of early identified acute kidney injury among critically ill obstetric patients

Background: Acute kidney injury (AKI) is one of the most challenging and serious complications of pregnancy and postpartum period that facing critical care nurses in Intensive Care Unit (ICU). Having a uniform standard for identifying and classifying AKI would enhance critical care nurses’ ability to recognize these patients and leading to better outcomes.Objective: This work aimed to explore the risk factors and outcome of early identified acute kidney injury of critically obstetric patients in Obstetric ICU. Design. A descriptive cross sectional research design was used in this study. Participants: A total sample of 338 women admitted to Obstetric ICU at Woman Health Hospital, Assiut City, Egypt. Method: Three tools were used.Tool I was developed by the researcher and included demographic and obstetric history, lab parameters, complications and outcomes arising from AKI. The Sequential Organ Failure Assessment (SOFA) score as tool II to determine the extent of a patient's organ function or rate of failure. Measurement of serum creatinine and urine output were used to early identify AKI stages according to Acute Kidney Injury Network (AKIN) Criteria (tool III). Results: The prevalence of AKI among obstetric patients admitted to obstetric ICU was 10.1%; of them 52.9% needed renal replacement therapy and the mortality rate was 29.4%. Postpartum hemorrhage was the most common cause of AKI and its prevalence was 41.2%. It was also found that 74.5% of AKI patients developed complications. Conclusion: AKI complicated 10.1% of total admitted women to the OICU in the studied period. Postpartum hemorrhage represents the most prevalent risk factors with a highly significant SOFA score compared to other risk factors as sever preeclampsia, eclampsia, HEELP &amp; APH with acute fatty liver.

The effect of resolution time of acute kidney injury on clinical outcomes.

Acute kidney injury (AKI) is a frequent and complex disease. It is not clearly defined whether its duration is related to adverse outcomes. We determined the effect of AKI resolution time on patient's clinical outcomes. A prospective cohort of hospitalized patients with AKI by AKI network (AKIN) creatinine criteria was included. Variables for prognosis and follow-up were analyzed. One hundred and thirteen patients were included in the study. Seventy-seven (68.1%) were males, mean age 55 years (range, 16–76 years), and 48 (42.5%) were diabetic. The most common cause of AKI was sepsis (31%). AKI resolution time ≤2 days and >2 days was seen in 47 (41.6%) and 66 (58.4%) of the cases, respectively. AKI resolution time >2 days was common in older patients (66.24 ± 17.6 year vs. 47.16 ± 12.32 year, P = 0.004), with the use of mechanical ventilation (27% vs. 4%, P = 0.02) and vasopressors (41% vs. 11%, P ≤ 0.01); it was associated with increased mortality (47% vs. 4%, P ≤ 0.01), and a discharge estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 (52% vs. 2%, P = 0.01), than in patients with resolution time ≤2 days. Survival rate was significantly worse in patients with a resolution time >2 days. By multivariate logistic step-wise regression analysis, AKI >2days, vasopressor use, and AKIN stage 2–3 were independently associated with higher mortality. AKI >2 days and vasopressor utilization were independently associated to an eGFR <60 ml/min/1.73 m2 at the time of discharge. We conclude that AKI resolution time >2 days is linked to adverse clinical outcomes.

Epidemiology, Clinical Characteristics and Outcome of Acute Kidney Injury in Intensive Care Units of Alexandria University Hospitals

1.1.Background: Acute kidney injury (AKI) considered as a major public health problem that affects millions of patients worldwide and leads to decreased survival and increased progression of chronic kidney disease (CKD). 1.2.Aim of study: Epidemiology, clinical characteristics and outcome of acute kidney injury in patients admitted to main Alexandria university hospitals over six months. 1.3.Methods:All patients who were admittedto intensive care units (ICUs) at Alexandria University Hospitals wereprospectively studied. Patients whodeveloped ICU-acquired acute renalfailure were collected in the period over six months. 1.4.Results:Our study included 500 patients in general ICU. General ICU patients classified according to renal impairment: 303 cases (no AKI) 60.6%, 74 cases (CKD) 14.8%, 55 cases (AKI) 11%, 38 cases (acute on top of CKD) 7.6%, 28 cases (ESRD) 5.6%, 2 cases (obstructive uropathy) 0.4%. Bimodal distribution of age in patients developed AKI at (18-30y) & (62-85y). 75 Toxicological cases, 3 developed AKI (2 organo phosphorus & 1 scorpion bite). The most common cause of AKI in our study was septic AKI 60% & among 128 cases of sepsis 32% not developed AKI/ 25.8% developed septic AKI 32% acute on top of CKD/10.2% ESRD. Mortality rate allover general ICU patients was 140/500 (28%) while allover AKI patients in general ICU 30/55(54%) and allover septic AKI 26/33(79%). 1.5.Conclusion:AKI is a worsening problem, but its true incidence is in need of huge work, our work was 1st up to our knowledge in Alexandria to check its incidence hence planning for better outcome.

Urine Interleukin 18 and Lipocalin 2 Are Biomarkers of Acute Tubular Necrosis in Patients With Cirrhosis: A Systematic Review and Meta-analysis

Acute kidney injury (AKI) is a common complication in patients with cirrhosis that increases mortality. The most common causes of AKI in these patients are prerenal azotemia, acute tubular necrosis (ATN), and hepatorenal syndrome; it is important to determine the etiology of AKI to select the proper treatment and predict patient outcome. Urine biomarkers could be used to differentiate between patients with ATN and functional causes of AKI. We performed a systematic review and meta-analysis of published studies to determine whether urine levels of interleukin (IL)18 and lipocalin 2 or neutrophil gelatinase-associated lipocalin (NGAL) are associated with the development of ATN in patients with cirrhosis. We searched MEDLINE, Scopus, ISI Web of Knowledge, and conference abstracts through December 31, 2015, for studies that assessed urine biomarkers for detection of acute kidney injury in patients with cirrhosis or reported an association between urine biomarkers and all-cause mortality in these patients. We included only biomarkers assessed in 3 or more independent studies, searching for terms that included urine biomarkers, cirrhosis, NGAL, and IL18. We calculated the pooled sensitivities and specificities for detection and calculated the area under the receiver operating characteristic curve (AUC) values using a bivariate logistic mixed-effects model. We used the χ2 test to assess heterogeneity among studies. We analyzed data from 8 prospective studies, comprising 1129 patients with cirrhosis. We found urine levels of the markers discriminated between patients with ATN and other types of kidney impairments, with AUC values of 0.88 for IL18 (95% confidence interval [CI], 0.79-0.97) and 0.89 for NGAL (95% CI, 0.84-0.94). Urine levels of IL18 identified patients who would die in the hospital or within 90 days (short-term mortality) with an AUC value of 0.76 (95% CI, 0.68-0.85); NGAL identified these patients with the same AUC (0.76; 95% CI, 0.71-0.82). In a systematic review and meta-analysis, we found that urine levels of IL18 and NGAL from patients with cirrhosis discriminate between those with ATN and other types of kidney impairments, with AUC values of 0.88 and 0.89, respectively. Urine levels of IL18 and NGAL identified patients with short-term mortality with an AUC value of 0.76. These biomarkers might be used to determine prognosis and select treatments for patients with cirrhosis.

Sodium Pentosan Polysulfate Reduced Renal Ischemia-Reperfusion-Induced Oxidative Stress and Inflammatory Responses in an Experimental Animal Model

Acute kidney injury (AKI) remains an independent risk factor for mortality and morbidity after vascular surgery (affecting the renal arteries) or aortic surgery (requiring suprarenal aortic clamping). These types of vascular surgery produce renal ischemia/reperfusion (I/R) injury, a common cause of AKI. The present studies aimed at monitoring the course of renal I/R injury at the cellular level and investigating the efficacy of long-term preoperative and single-shot intraoperative administration of sodium pentosan polysulfate (PPS) to protect renal tissue from acute I/R injury both in native and diabetic kidneys in rats. Western blot analyses of the proapoptotic (bax) and antiapoptotic (bcl-2) signaling pathways, as well as the extent of DNA damage (phospho-p53), were performed. Oxidative stress followed upon the termination of malondialdehyde, reduced glutathione, thiol group, and superoxide dismutase plasma levels. Inflammatory changes were measured by the determination of serum tumor necrosis factor-α and interleukin-1 levels. Morphological changes were detected by histological examinations. Our results showed that the long-term administration of PPS has an advantage in reducing I/R kidney injury in diabetic rats, while high-dose, single-shot parenteral administration of PPS prior to revascularization might be useful in nondiabetic rats.

Etiology and outcome of Neonatal Acute Kidney Injury in a Special Care Baby Unit

Background : The cause of acute kidney injury (AKI) in neonate is multifactorial. The short-term outcome of AKI in newborns is highly dependent on the underlying etiology, the condition of other organs, and the facilities for renal replacement therapy.Objective : The aims of the present study were to find out the etiology and immediate outcome of AKI in neonate.Methodology : This observational study was done over a period of six months, at special care baby unit (SCABU) in Dhaka Medical College Hospital (DMCH). Neonates (aged 3-28 days) admitted in SCABU, who had AKI were the study population. Among them 44 neonates with AKI were included purposivly. AKI was diagnosed and classified by pediatric RIFLE (pRIFLE) staging criteria. Etiology of AKI was find out by dividing pre renal, renal and post renal cause of AKI. All neonates were treated conservatively and with intermittent peritoneal dialysis (IPD) as needed. Immediate hospital outcome was determined by improved with normal renal functions; improved with impaired renal functions and death.Result : The diagnosis based on estimated creatinine clearance (eCCL) criteria of pRIFLE showed that 43.2% neonates were at risk (R) stage, 22.7% were at injury (I) stage and 34.1% of neonates were at Failure (F) stage of AKI. Among 44 neonates 21 were male and 23 were female. Pre renal cause of AKI is predominant in this series. More than two-thirds (68.2%) of the neonates experienced perinatal asphyxia stage-II and III and 52.3% were exposed to meconium stained liquor during delivery. Septicemia with shock, history of aminoglycoside use were reported to be 59.1%, 52.3% respectively. Post renal cause was found in 16% neonates, like obstructive uropathy due to posterior urethral valve, exstrophy bladder and cloacal exstrophy. Neonate at Failure stage of AKI (n=15) had a significantly longer stay at SCABU (p &lt; 0.001). Multiorgan failure was found to be significantly higher in failure group (p = 0.026). Majority of the failure group needed dialysis (p &lt; 0.001). Most of the neonate at risk and injury stage was improved with normal renal functions. The resolution from AKI was almost similar among the groups (p = 0.885). The mortality was progressively higher from Risk to Failure Groups (p = 0.106). Overall 27% of the neonates diagnosed as AKI died from this illness, 57% improved with normal renal function and 16% improved with impaired renal function.Conclusion : The study concluded that perinatal asphyxia, septicemia with shock and use of aminoglycosides were the commonest cause of AKI in neonate. The mortality was higher in Failure group.Northern International Medical College Journal Vol.7(2) Jan 2016: 127-130

Clinical spectrum of acute kidney injury among hospitalized patients in coastal districts of Andhra Pradesh

Introduction: Acute kidney injury (AKI) is one of the important overall causes of mortality in hospitalized patients. Variability in definitions of AKI has led to gross variations in the incidence across the world. Multiple metabolic derangements in these patients can increase the mortality and morbidity. Our study aims at studying the incidence, clinical, biochemical, hematological and sonographic abnormalities seen in hospitalized patients with AKI. Methods and Material: Case records of 237 patients admitted in various departments of a tertiary care center over a three year period from 2010 to 2013, who developed AKI were included in the study. The etiologies, various hematological and biochemical test reports, ultrasonography of abdomen and treatment given was noted. Statistical analysis was done to find the pattern of AKI and the prevalence of various biochemical and metabolic abnormalities. Results: The incidence of AKI among hospitalized patients was 1.9%. Out of 237 patients with AKI, 62% were males. 70% belonged to medical and allied specialties. The most common cause of AKI was infection related. Fever was the most common symptom (48%) and common laboratory abnormalities included anemia (70%), hyperkalemia (36%) and proteinuria (29%). Mortality in this study was 21 (9%), 73% received conservative therapy while 27% had undergone hemodialysis. Conclusions: AKI is highly prevalent among hospitalized patients admitted in medical and allied departments. Infections top the list among the causes of AKI. Various metabolic and biochemical abnormalities are seen, most of them can be managed conservatively and up to one third may require hemodialysis.

Early initiation of continuous renal replacement therapy improves survival of elderly patients with acute kidney injury: a multicenter prospective cohort study

BackgroundContinuous renal replacement therapy (CRRT) is essential in the management of critically ill patients with acute kidney injury (AKI). However, the optimal timing for initiating CRRT remains controversial, especially in elderly patients. Therefore, we investigated the outcomes of early CRRT initiation in elderly patients with AKI.MethodsA total of 607 patients ≥65 years of age who started CRRT due to AKI between August 2009 and December 2013 were prospectively enrolled. They were divided into two groups based on the median 6-hour urine output immediately before CRRT initiation. Propensity score matching was used to compare the overall survival rate, CRRT duration, and hospitalization duration.ResultsThe median age of both groups was 73.0 years, and 60 % of the patients were male. The most common cause of AKI was sepsis. In the early CRRT group, the mean arterial pressure was higher, but the prothrombin time and total bilirubin, aspartate aminotransferase, and alanine aminotransferase levels were lower. The overall cumulative survival rate was higher in the early CRRT group (log-rank P < 0.01). Late CRRT initiation was associated with a higher mortality rate than early initiation after adjusting for age, sex, the Charlson comorbidity index, systolic arterial pressure, prothrombin time, the total bilirubin, aspartate aminotransferase, and alanine aminotransferase levels, cumulative fluid balance and diuretic use (hazard ratio, 1.35; 95 % confidence interval 1.06, 1.71, P = 0.02). Following propensity score matching, patient survival was significantly better in the early CRRT group than in the late CRRT group (P < 0.01). The total duration of hospitalization from the start of CRRT was shorter among the survivors when CRRT was started earlier (26.7 versus 39.1 days, P = 0.04).ConclusionA better prognosis can be expected if CRRT is applied early in the course of AKI in critically ill, elderly patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1437-8) contains supplementary material, which is available to authorized users.

The ISN 0by25 Global Snapshot Study

The International Society of Nephrology's (ISN) 0by25 initiative aims to prevent avoidable deaths from acute kidney injury (AKI) by 2025, most of which occur in low and lower middle-income countries (LLMICs). To increase evidence about the epidemiology of AKI, especially in LLMICs, ISN conducted a ‘Global Snapshot', a multinational, cross-sectional study in which 322 physicians from 72 countries in 6 continents identified 3,664 adults and 354 children with AKI who were under their care of which 45% were from LLMICs, nevertheless low-income countries were under-represented. In LLMICs, patients with AKI were younger, and community acquired AKI was more common. Hypotension (40%) and dehydration (39%) were the most common causes of AKI. Dehydration was a more common cause in LLMIC, as were sepsis, pregnancy-related AKI and animal envenomation. Acute dialysis was performed in 23% of patients. Eight percent had a clinical indication for this but were not dialyzed. In LLMICs, lack of resources (16%) and inability to afford therapy (30%) accounted for almost half of these cases. Overall mortality at 7 days was 11% and was higher in LLMICs. Complete recovery from AKI occurred in 30% of patients and partial recovery 37%, and was more often complete in LLMICs. The 0by25 Global Snapshot provides new information about the worldwide epidemiology of AKI, helping to identify elements that would be amenable in intervention to reduce preventable deaths.

Aetiologies and Short-term Outcomes of Acute Kidney Injury in a Tertiary Centre in Southwest Nigeria.

Acute kidney injury (AKI) has become a global health problem and is associated with increased morbidity, mortality and overall health expenditure. Information on the epidemiology and outcomes of AKI will help to audit practice and advocate for policies that will reduce this burden. This study determined aetiologies, short term outcomes and their predictors in AKI patients in a tertiary hospital in Southwest Nigeria. This was an 18-month retrospective study that involved 91 patients with AKI. The socio-demographic information, aetiology, severity and the treatment given to patients were recorded. Outcomes and their predictors were determined using multivariate analysis. P value < 0.05 was taken as statistically significant. The mean age of the study population was 45.12 ±20.67 years. Common causes of AKI were sepsis in 50(54.9%), hypovolaemia in 23(25.3%), cardiac failure in 7(7.7%) and eclampsia in 6(6.6%). Fifty-seven (62.6%) presented with stage 3. Thirty-one (34.1%) had haemodialysis. Forty-eight (52.7%) had complete renal recovery, 35(38.5%) died and 3(3.3%) left against medical advice while five (5.5%) were referred to other hospitals. Stage 3 AKI (Adjusted odd ratio: 6.79, confidence interval: 1.21:38.04, p = 0.029) and age ≥ 65 years (Adjusted odd ratio: 4.14, confidence interval: 1.32-13.04, p = 0.015) were significant predictors of mortality in AKI patients. Sepsis and hypovolaemia were the commonest causes of AKI. The associated mortality is still high and factors associated with mortality were late presentation and older age. Early presentation, treatment and making haemodialysis affordable are key to improving AKI outcomes.

A Clinical Study of Acute Kidney Injury in Tropical Acute Febrile Illness.

Tropical Acute Febrile Illness (TAFI) is one of the most common causes of morbidity within the community. Acute Kidney Injury (AKI) due to infective and non infective causes is a major complication. Presence of AKI is a major cause of mortality among patients with TAFI. To study the spectrum of tropical acute febrile illness; the proportion, spectrum and staging of acute kidney injury; Renal Replacement Therapy (RRT) initiation and in-hospital mortality. A total of 600 TAFI patients were prospectively studied at a tertiary care centre in coastal Karnataka between September 2012 and September 2014 for the aetiology of TAFI; the development and staging of AKI based on Kidney disease: Improving global outcomes (KDIGO) guidelines; the initiation of RRT and in-hospital mortality. Data analysis was done using SPSS version 17.0 with statistical significance calculated using chi-square and Fisher's exact t-test for which p-value <0.05 was considered significant. The spectrum of TAFI, in decreasing order, was vivax malaria, leptospirosis, dengue fever, falciparum malaria, mixed malaria, enteric fever, scrub typhus and the most common aetiology was malaria. The proportion of AKI was 54%. The most common cause of AKI, its stages 2 and 3, RRT initiation and in-hospital mortality was leptospirosis; and AKI stage 1 was dengue fever. KDIGO AKI stage 1, 2 and 3 was seen in 46.9%, 31.2% and 21.9% of AKI patients, respectively. RRT initiation was required in 10.2% of AKI patients and in-hospital mortality was 3% among all patients. AKI, RRT initiationand in-hospital mortality were significantly associated with older age, fever duration and other presenting complaints, examination findings, renal function and other parameters, leptospirosis, dengue fever, falciparum malaria. The aetiology in about half of TAFI patients in coastal Karnataka was malaria. More than 50% develop AKI with greater than one-fifth of them progressing to AKI stage 3 and one-tenth requiring RRT. The most common cause of AKI, AKI stage 2, 3, RRT initiation and in-hospital mortality was leptospirosis. AKI was present in almost all patients with leptospirosis. Therefore leptospirosis was the most nephrotoxic acute febrile illness in the present study population. Dengue fever was the most common cause of AKI stage 1. Vivax malaria was the third most common cause of AKI. The factors like age, presenting complaints, examination findings, renal function and other parameters, aetiology and RRT initiation may be used to predict AKI and in-hospital mortality.

Characteristics of acute kidney injury in adult patients in a tertiary health facility in northern Nigeria

Introduction: Acute kidney injury (AKI) is a complex renal disorder with multiple etiologies and manifestations which vary widely between regions and populations and it is associated with an increased mortality. It is defined by abrupt rise in serum creatinine and/or decrease in urine output to below 0.5 ml/kg/h. Materials and Methods: Patients' records from January 2013 to December 2014 were reviewed retrospectively, and data from those who satisfied the definition of AKI were extracted for analysis using the Statistical Package for Social Sciences software version 17. Results were presented as means, frequencies, and percentages, and the significance of relationships was investigated using t-test or Chi-square test as appropriate. Results: Three hundred and twenty patients, 2.3% of the total hospital adult admissions and 12.5% of adult medical admissions, had AKI. There were 162 (50.6%) males with a mean age of 38.51 ± 16.574 years and 158 (49.4%) females with a mean age of 31.22 ± 13.471 years. The most common causes of AKI were sepsis (37.2%), diarrhea and vomiting (27.5%), and hemorrhage (16.9%). Of those who had sepsis, 70/119 (58.8%) were females while 70/88 (79.5%) of those with diarrhea and vomiting were males. Most patients (58.1%) presented with Stage 3 injuries which had a significant influence on renal outcome and mortality. Anemia was more common in females, i.e., 85/158 (53.8%) than males, i.e., 11/162 (6.8%), but it did not have a significant influence on the severity of injury and the overall outcome. We conclude that AKI is not uncommon in our environment and the outcome depends on the etiology and severity of injury. Hemodialysis treatment given when indicated improved the overall outcome.

Incidence of pediatric acute kidney injury in hospitalized patients.

Pediatric acute kidney injury (pAKI) is a common complication associated with high mortality in children. The objective of this study was to determine the incidence of acute kidney injury (AKI) and mortality in hospitalized (critically ill and non-critically ill) patients. This was a retrospective study conducted during the period of June 1, 2013, to May 31, 2014, at the Postgraduate Department of Pediatrics, G. B. Pant Hospital, an Associated Hospital of Government Medical College, Srinagar, Jammu and Kashmir, India. All patients between the ages of one month and 18 years were included in the study, who had AKI. In general, out of 23,794 patients, 197 developed AKI (0.8%). On subgroup analysis, 2460 were critically ill and had Intensive Care Unit (ICU) admission among whom 99 developed AKI (4%), whereas 21,334 had general pediatric ward admissions and 98 developed AKI (0.5%). Infantile age group was the most commonly 91 (46.2%) affected. The common causes of AKI were renal in 73 (37%), neurologic in 38 (19%), septicemia in 35 (18%), and inborn errors of metabolism in 30 (15.2%). Out of 197 pAKI patients, 42 (21.3%) died and all of them were critically sick (ICU admissions). The incidence of pAKI in general was 0.8%, whereas it was 4% in critically ill children and 0.5% in general ward admissions implying an eight-fold increased risk of pAKI in critically ill patients.