Study the Outcome and Prognosis of Acute Kidney Injury in Pediatric Patients

Abstract

Title: Study the outcome and prognosis of acute kidney injury in pediatric patients. Background: Acute renal failure (ARF) is associated with severe morbidity especially in children due to existence of more than 30 definitions of ARF in literature, leading to large variations in the reported incidence and outcome, the term ARF was replaced by AKI to provide uniform definition and classification and standardize patient care1,2. Aims and objectives: To study the etiological factors for acute kidney injury and assess associated acute kidney injury as a prognostic factor. Material and methods: The study was conducted in Pediatric intensive care unit of Department of Pediatrics of SBKS medical college and Dhiraj hospital, Baroda. Type of study: Prospective study. Inclusion criteria: patients aged one month to 17 years admitted to pediatric intensive care unit at Dhiraj hospital Baroda. Exclusion criteria: patients with known chronic kidney disease and patients not giving consent. Permission from institutional ethics committee, sbks medical college was taken, following this a well informed parental consent was taken and clinical history and examination was done. In consultation with chief of PICU etiological diagnosis was considered. Serum creatinine levels were estimated at admission and at daily intervals till discharge from PICU. Base line serum creatinine was determined by using backward calculation as recommended by KIDGO for given age within 48 hours of admission staging of AKI was done by pRIFLE and AKIN staging. Data of the XI patients were reviewed and assigned pRIFLE and AKIN staging depending on eCrCland serum creatinine respectively. Results: Of 50 patients included in the study 33(66%) male, 17(34%) female with maximum age of presentation 3.1 to 8 years and mean duration of stay 6.4 days. Staging of AKI was done with pRIFLE and AKIN staging suggesting pRIFLE is more rapid in picking patients of AKI in I category in comparison to stage 2 of AKIN staging. Mortality risk increased with progression of staging of AKI. Urine output was not useful in staging of AKI in our study. The commonest etiology for patients with AKI was sepsis 15(30%) of total patients of which 5(33.3%) patients had pneumonia.2nd most common etiology was acute tropical illness accounting total 7(14%) of which 6(85.7%) were of dengue febrile illness and 14.3%(1) with complicated malaria.3(6%) patients had metabolic acidosis, 1(2%) with hyperkalemia, 8(16%) with hypernatremia.32(64%) required inotrope support, 11(22%) were on mechanical ventilation,7(14%) were given renal replacement therapy. Patients on mechanical ventilation had poor outcome with 36.4% expired and 63.6% took DAMA.Of patients who were on renal replacement therapy (42.8%) were on peritoneal dialysis, (57.2%) were on hemodialysis. Overall outcome of patients was 26(52%) discharged,12(24%) went DAMA, 8(16%) referred,4(8%) expired.Of 4 patient expired following were the diagnosis, ARDS with AKI, sepsis with AKI, Subacute intestinal obstruction post op with sepsis,dengue with septic shock with AKI. Of 4 patients 2 were in INJURY and 2 were in failure category on the basis estimated creatinine clearance criteria where as on the serum creatinine criteria, stage 3 had 100% mortality. XII Conclusion: There is paucity of AKI related literature and studies in Indianscenario.More studies are required to prove benefits of pRIFLE or AKIN staging. But the common cause for AKI was sepsis, next to it was acute tropical illness. Perhaps control on vectorborne disease may significantly reduce burden of aki. Also pRIFLE helps in picking up patients on AKI early as compared to AKIN staging.