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VOLUME 20 , ISSUE 9 ( 2016 ) > List of Articles

BRIEF COMMUNICATION

Acute kidney injury in pediatric intensive care unit: Incidence, risk factors, and outcome

Sheetal Gupta, Ghanshyam Sengar, Praveen K. Meti, Anil Lahoti, Mukesh Beniwal, Murlidhar Kumawat

Keywords : Acute kidney injury, critically ill children, Pediatric Intensive Care Unit, pRIFLE

Citation Information : Gupta S, Sengar G, Meti PK, Lahoti A, Beniwal M, Kumawat M. Acute kidney injury in pediatric intensive care unit: Incidence, risk factors, and outcome. Indian J Crit Care Med 2016; 20 (9):526-529.

DOI: 10.4103/0972-5229.190368

License: CC BY-ND 3.0

Published Online: 01-09-2016

Copyright Statement:  Copyright © 2016; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Objective: To determine incidence, risk factors, and outcome of acute kidney injury (AKI) in Pediatric Intensive Care Unit (PICU). Materials and Methods: This is a prospective, observational study conducted in PICU of Department of Paediatrics, S.P. Medical College, Bikaner, from October 2013 to May 2014. In this study, 536 patients of aged 29 days to 16 years were screened for AKI according to the Pediatric Risk, Injury, Failure, Loss, End-stage Renal Disease (pRIFLE) criteria. Their clinical and biochemical data were recorded and followed up to their discharge/death. Results: During the study period, 230 (42.9%) out of 536 patients developed AKI. Younger age (<5 years) and females (P ≤ 0.013) were more prone to develop AKI. Most common etiologies were septicemia, multiple organ dysfunction syndrome (MODS), gastroenteritis, and severe malaria (P ≤ 0.05). The maximal stage of AKI was stage “R” (49.1%), followed by “I” (29.5%) and “F” (21.3%). Major PICU-related risk factors were use of vasoactive drug (VD) and nephrotoxic drug (ND) and need of mechanical ventilation (MV) (P ≤ 0.05). Length of stay was significantly longer than non-AKI patients (P ≤ 0.05). Mortality in AKI (47.5%) was higher (P ≤ 0.05%) in comparison to non-AKI (25.56%). Conclusion: AKI is common in critically sick children, especially in younger age and in females with septicemia and MODS. Use of VD and ND and need of MV are common risk factors. AKI is associated with longer hospital stay and higher mortality. pRIFLE is better diagnostic criteria in early detection of AKI and reduction of their morbidity and mortality.


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  1. Plötz FB, Hulst HE, Twisk JW, Bökenkamp A, Markhorst DG, van Wijk JA. Effect of acute renal failure on outcome in children with severe septic shock. Pediatr Nephrol 2005;20:1177-81.
  2. Mehta P, Sinha A, Sami A, Hari P, Kalaivani M, Gulati A, et al. Incidence of acute kidney injury in hospitalized children. Indian Pediatr 2012;49:537-42.
  3. 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.
  4. 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.
  5. Ostermann M, Chang RW. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med 2007;35:1837-43.
  6. 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.
  7. Bagshaw SM, George C, Dinu I, Bellomo R. A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically ill patients. Nephrol Dial Transplant 2008;23:1203-10.
  8. Freire KM, Bresolin NL, Farah AC, Carvalho FL, Góes JE. Acute kidney injury in children: Incidence and prognostic factors in critical ill patients. Rev Bras Ter Intensiva 2010;22:166-74.
  9. Krishnamurthy S, Mondal N, Narayanan P, Biswal N, Srinivasan S, Soundravally R. Incidence and etiology of acute kidney injury in Southern India. Indian J Pediatr 2013;80:183-9.
  10. Soler YA, Nieves-Plaza M, Prieto M, García-De Jesús R, Suárez-Rivera M. Pediatric risk, injury, failure, loss, end-stage renal disease score identifies acute kidney injury and predicts mortality in critically ill children: A prospective study. Pediatr Crit Care Med 2013;14:e189-95.
  11. Naik S, Sharma J, Yengkom R, Kalrao V, Mulay A. Acute kidney injury in critically ill children: Risk factors and outcomes. Indian J Crit Care Med 2014;18:129-33.
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