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VOLUME 17 , ISSUE 4 ( August, 2013 ) > List of Articles

RESEARCH ARTICLE

Clinical profile of acute kidney injury in a pediatric intensive care unit from Southern India: A prospective observational study

Nivedita Mondal, Parameswaran Narayanan, Sivaprakasam Prabha, Subramanian Mahadevan, Niranjan Biswal, Sadagopan Srinivasan

Keywords : Acute kidney injury, critically ill-children, pediatric intensive care unit

Citation Information : Mondal N, Narayanan P, Prabha S, Mahadevan S, Biswal N, Srinivasan S. Clinical profile of acute kidney injury in a pediatric intensive care unit from Southern India: A prospective observational study. Indian J Crit Care Med 2013; 17 (4):207-213.

DOI: 10.4103/0972-5229.118412

License: CC BY-ND 3.0

Published Online: 01-08-2013

Copyright Statement:  Copyright © 2013; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Although the term acute renal failure was replaced by acute kidney injury (AKI) recently, there is a paucity of data on the incidence and profile of AKI in critically ill children from the developing world. Objectives: The objective of this study is to determine the incidence, etiology, short term outcome and predictors of fatality in critically ill children admitted to the pediatric intensive care unit (PICU) with AKI, aged 1 month to 13 years. Materials and Methods: In this prospective observational study, from June 2010 to March 2011, 215 children admitted to the PICU were screened for AKI, defined according to the AKI Network criteria. The patients with AKI were followed-up until discharge/death. Their clinical and biochemical data were recorded. Results: The incidence of AKI among 215 patients screened was 54 (25.1%). The common etiologies were infections, [34 (62.9%)], acute glomerulonephritis (7.6%), snake envenomation (5.7%), hemolytic uremic syndrome (3.8%) and congestive cardiac failures (3.8%). Among infections, pneumonia and septicemia constituted 26.5% each, meningoencephalitis accounted for 23.5%, and dengue, scrub typhus, tuberculosis and malaria constituted 9.3% of children with AKI. 27.8% of patients required dialysis. Overall mortality was 46.3%. On logistic regression analysis, requirement of mechanical ventilation was an independent predictor of fatality in AKI. Conclusions: Besides the high incidence of AKI in critically ill-children admitted to the PICU (25.1%), the condition was associated with adverse outcomes, including high mortality (46.3%) and need for dialysis (27.8%). Infections dominated the etiological profile. Requirement of mechanical ventilation predicted an adverse outcome in our patient population.


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  1. Cerdá J, Bagga A, Kher V, Chakravarthi RM. The contrasting characteristics of acute kidney injury in developed and developing countries. Nat Clin Pract Nephrol 2008;4:138-53.
  2. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative workgroup. Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs: The second International consensus conference of the acute dialysis quality initiative (ADQI) group. Crit Care 2004;8:R204-12.
  3. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute kidney injury network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31.
  4. Plötz FB, Bouma AB, van Wijk JA, Kneyber MC, Bökenkamp A. Pediatric acute kidney injury in the ICU: An independent evaluation of pRIFLE criteria. Intensive Care Med 2008;34:1713-7.
  5. Palmieri T, Lavrentieva A, Greenhalgh D. An assessment of acute kidney injury with modified RIFLE criteria in pediatric patients with severe burns. Intensive Care Med 2009;35:2125-9.
  6. Schneider J, Khemani R, Grushkin C, Bart R. Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit. Crit Care Med 2010;38:933-9.
  7. Zappitelli M, Moffett BS, Hyder A, Goldstein SL. Acute kidney injury in non-critically ill children treated with aminoglycoside antibiotics in a tertiary healthcare centre: A retrospective cohort study. Nephrol Dial Transplant 2011;26:144-50.
  8. Duzova A, Bakkaloglu A, Kalyoncu M, Poyrazoglu H, Delibas A, Ozkaya O, et al. Etiology and outcome of acute kidney injury in children. Pediatr Nephrol 2010;25:1453-61.
  9. Ratanarat R, Hantaweepant C, Tangkawattanakul N, Permpikul C. The clinical outcome of acute kidney injury in critically ill Thai patients stratified with RIFLE classification. J Med Assoc Thai 2009;92 Suppl 2:S61-7.
  10. Vachvanichsanong P, Dissaneewate P, Lim A, McNeil E. Childhood acute renal failure: 22-year experience in a university hospital in southern Thailand. Pediatrics 2006;118:e786-91.
  11. Cruz DN, Bolgan I, Perazella MA, Bonello M, de Cal M, Corradi V, et al. North East Italian prospective hospital renal outcome survey on acute kidney injury (NEiPHROS-AKI): Targeting the problem with the RIFLE Criteria. Clin J Am Soc Nephrol 2007;2:418-25.
  12. Bowers LD, Wong ET. Kinetic serum creatinine assays. II. A critical evaluation and review. Clin Chem 1980;26:555-61.
  13. Goldstein B, Giroir B, Randolph A, International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005;6:2-8.
  14. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114:555-76.
  15. Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int 2007;71:1028-35.
  16. Otukesh H, Hoseini R, Hooman N, Chalian M, Chalian H, Tabarroki A. Prognosis of acute renal failure in children. Pediatr Nephrol 2006;21:1873-8.
  17. Shaheen IS, Watson AR, Harvey B. Acute renal failure in children: Etiology, treatment and outcome. Saudi J Kidney Dis Transpl 2006;17:153-8.
  18. Ghani AA, Al Helal B, Hussain N. Acute renal failure in pediatric patients: Etiology and predictors of outcome. Saudi J Kidney Dis Transpl 2009;20:69-76.
  19. Srivastava RN, Choudhry VP. Acute renal failure in Delhi. Indian J Pediatr 1982;49:65-70.
  20. Srivastava RN, Bagga A, Moudgil A. Acute renal failure in north Indian children. Indian J Med Res 1990;92:404-8.
  21. Williams DM, Sreedhar SS, Mickell JJ, Chan JC. Acute kidney failure: A pediatric experience over 20 years. Arch Pediatr Adolesc Med 2002;156:893-900.
  22. Ozçakar ZB, Yalçinkaya F, Altas B, Ergün H, Kendirli T, Ateş C, et al. Application of the new classification criteria of the acute kidney injury network: A pilot study in a pediatric population. Pediatr Nephrol 2009;24:1379-84.
  23. Sinha R, Nandi M, Tullus K, Marks SD, Taraphder A. Ten-year follow-up of children after acute renal failure from a developing country. Nephrol Dial Transplant 2009;24:829-33.
  24. Muntner P, Warnock DG. Acute kidney injury in sepsis: Questions answered, but others remain. Kidney Int 2010;77:485-7.
  25. Akram AR, Singanayagam A, Choudhury G, Mandal P, Chalmers JD, Hill AT. Incidence and prognostic implications of acute kidney injury on admission in patients with community-acquired pneumonia. Chest 2010;138:825-32.
  26. Basu G, Chrispal A, Boorugu H, Gopinath KG, Chandy S, Prakash JA, et al. Acute kidney injury in tropical acute febrile illness in a tertiary care centre: RIFLE criteria validation. Nephrol Dial Transplant 2011;26:524-31.
  27. Barsoum RS. Tropical acute renal failure. Contrib Nephrol 2004;144:44-52.
  28. Pahari A, Walters MD, Levin M. Infectious diseases and the kidney. In: Avner ED, Harmon WE, Niaudet P, editors. Textbook of Paediatric Nephrology. 5 th ed. Philadelphia, USA: Lippincott Williams and Wilkins; 2004. p. 954-85.
  29. Boonpucknavig V, Soontornniyomkij V. Pathology of renal diseases in the tropics. Semin Nephrol 2003;23:88-106.
  30. Hommel D, Talarmin A, Reynes JM, Hulin A. Acute renal failure associated with dengue fever in French Guiana. Nephron 1999;83:183.
  31. Mallinson WJ, Fuller RW, Levison DA, Baker LR, Cattell WR. Diffuse interstitial renal tuberculosis: An unusual cause of renal failure. Q J Med 1981;50:137-48.
  32. Anandh U, Renuka S, Somiah S, Vincent L. Acute renal failure in the tropics: Emerging trends from a tertiary care hospital in South India. Clin Nephrol 2003;59:341-4.
  33. Vijayakumar M. Acute and crescentic glomerulonephritis. Indian J Pediatr 2002;69:1071-5.
  34. Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: A cohort analysis. Crit Care 2006;10:R73.
  35. Franzen D, Rupprecht C, Hauri D, Bleisch JA, Staubli M, Puhan MA. Predicting outcomes in critically ill patients with acute kidney injury undergoing intermittent hemodialysis: A retrospective cohort analysis. Int J Artif Organs 2010;33:15-21.
  36. Askenazi DJ, Feig DI, Graham NM, Hui-Stickle S, Goldstein SL. 3-5 year longitudinal follow-up of pediatric patients after acute renal failure. Kidney Int 2006;69:184-9.
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