Acute kidney injury (AKI), Pediatric intensive care unit (PICU), pRIFLE, Viral encephalitis, Scrub typhus
Citation Information :
Bharat A, Mehta A, Tiwari HC, Sharma B. Spectrum and Immediate Outcome of Acute Kidney Injury in a Pediatric Intensive Care Unit: A Snapshot Study from Indian Subcontinent. Indian J Crit Care Med 2019; 23 (8):352-355.
Background and aims: Acute kidney injury (AKI) became an important cause of mortality and morbidity in critically ill children, despite advancement in its management. In developing countries etiology of AKI are different from that of developed countries.
Materials and methods: This observational study was carried out in pediatric intensive care unit (PICU) in 2 months to 18 years of critically ill children. Kidney injury was defined and categorized by the pRIFLE criteria.
Results: Out of 361children, 86 children (23.8%) developed AKI at some point during admission, 275 children (age and sex matched) who did not develop kidney injury during hospitalization served as non-AKI children. Maximum cases of AKI were seen in 1–5 years of age. Maximum children of AKI were of viral encephalitis (n = 43, 50.0%) followed by scrub typhus (n = 14, 16.3%). Risk factors for the development of AKI were shock, PRISM score and longer hospital stay. In our study the mortality in AKI children (n = 30, 34.8%) was significantly higher (p = 0.005) as compared to non-AKI children (n = 56, 20.3%)). Duration on mechanical ventilation, PICU stay and hospital stay were also significantly (p = 0.001) higher in AKI children.
Conclusion: AKI is common in critically ill children and associated with high mortality and morbidity.
Andreoli S. Clinical evaluation and management. In: Avner E, Harmon W, Niaudet P, editors. Pediatric Nephrology. Philadelphia: Lippincott Williams and Wilkins; 2004. p. 1233–12352.
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;38:933–939.
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;35:2125–2129.
Thomas ME, Blaine C, Dawnay A, Devonald MA, Ftouh S, Laing C, et al. The definition of acute kidney injury and its use in practice. Kidney Int. 2015;87:62–73.
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;71:1028–1035.
Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Children. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012;2:1–138.
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.
Mehta P, Sinha A, Sami A, Hari P, Kalaivani M, Gulati A, et al. Incidence of Acute Kidney Injury in hospitalized children. Ind Pediatr 2012;49(7):537–542.
Bandoria P, Bhagwat AG. Severity scoring systems in pediatric intensive care unit. Indian Journal of anesthesia. 2008;52:(5):663–675.
Prasad Gullipalli, Anjani A. Spectrum of Paediatric Acute Kidney Injury – A Referral Hospital Experience in a Developing Nation, Journal of Dental Medical Sciences (IOSR-JDMS) February 2015; 14(Issue 2): 80–87.
Schwartz GJ, Muñoz A, Schneider MF. New equations to estimate GFR in children with CKD. Journal of the American Society of Nephrology. 2009:20(3):629–637.
Bowers LS, Wong ET. Kinetic serum creatinine assay II. A critical analysis and review. Clin Chem. 1980;26:555–561.
Restrepo de Rovetto C, Mora JA, Alexandre Cardona S, Marmolejo AF, Paz JF, de Castaño I. Acute kidney injury applying pRifle scale in Children of Hospital Universitario del Valle in Cali, Colombia: clinical features, management and evolution. Colombia Médica. 2012 Jul;43(3):200–205.
Alkandari O, Eddington KA, Hyder A, Gauvin F, Ducruet T, Gottesman R, et al. Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: a two-centre retrospective cohort study. Critical care. 2011 Jun;15(3):R146.
Krishnamurthy V, Shetty AK, Jaidev MD. Clinicoetiological profile of acute kidney injury in pediatric intensive care unit patients. Int J Contemp Pediatr 2016;3:1416–1418.
Wejdan Al-jboor, Reham Al mardini, Jwaher Al Bderat, Mahdi Frehat, Hazem Al Masri, Mohammad Saleh Alajloni. Acute Kidney Injury in Critically Ill Child. Saudi J Kidne Dis Transpl 2016;27(4):740–747.
Sriram Krishnamurthy, Parameswaran Narayanan, Sivaprakasam Prabha, Nivedita Mondal, Subramanian Mahadevan, Niranjan Biswal, et al. Clinical profile of acute kidney injury in a pediatric intensive care unit from Southern India: A prospective observational study. India J Crit Care Med. 2013 Jul-Aug;17(4):207–213.
Polo JG, Romero AA, Gil-Esparza MG, Cid JL, San Prudencio MG, Lafever SF, et al. Morbidity and mortality associated with acute kidney injury in patients admitted to pediatric intensive care units. Intensive medicine. 2014 Oct1;38(7):430–437.
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;18:129–133.
Mehta P, Sinha A, Sami A, Hari P, Kalaivani M, Gulati A, et al. Incidence of acute kidney injury in hospitalized children. Indian pediatrics. 2012 Jul 1;49(7):537–542.
Gupta S, Sengar GS, 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;20:526–529.
Miklaszewska M, Korohoda P, Sobczak A, Horbaczewska A, Filipiak A, Zachwieja K, et al. Acute kidney injury in a single pediatric intensive care unit in poland: a retrospective study. Kidney and Blood Pressure Research. 2014;39(1):28–39.
Bhatt GC, Bondre VP, Sapkal GN, Sharma T, Kumar S, Gore MM, et al. Changing clinico-laboratory profile of encephalitis patients in the eastern Uttar Pradesh region of India. Tropical Doctor. 2012;42(2):106–108.
Murhekar MV, Mittal M, Prakash JA, Pillai VM, Mittal M, Kumar CG, et al. Acute encephalitis syndrome in Gorakhpur, Uttar Pradesh, India–Role of scrub typhus. Journal of Infection. 2016 Dec 1;73(6):623–626.
Kumar V, Kumar V, Yadav AK, Iyengar S, Bhalla A, Sharma N, et al. Scrub typhus is an under-recognized cause of acute febrile illness with acute kidney injury in India. PLoS neglected tropical diseases. 2014 Jan 30;8(1):e2605.
Kumar M, Krishnamurthy S, Delhi kumar CG, Narayanan P, Biswal N, Srinivasan S. Scrub typhus in children at a tertiary hospital in southern India: clinical profile and complications. Journal of infection and public health. 2012 Feb 1;5(1):82–88.
Attur RP, Kuppasamy S, Bairy M, Nagaraju SP, Pammidi NR, Kamath V, et al. Acute kidney injury in scrub typhus. Clinical and experimental nephrology. 2013 Oct 1;17(5):725–729.
Palanivel S, Nedunchelian K, Poovazhagi V, Raghunadan R, Ramachandran P. Clinical profile of scrub typhus in children. The Indian Journal of Pediatrics. 2012 Nov 1;79(11):1459–1462.
Alkandari O, Eddington KA, Hyder A, Gauvin F, Ducruet T, Gottesman R, et al. Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: A two centre retrospective cohort study. Critical Care 2011;15:R146.