DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20190742

Acute kidney injury in paediatric intensive care: need for extended vigil

Saritha P. J., Jayakrishnan M. P., Ashraf T. P., Geeta M. G.

Abstract


Background: Acute kidney injury (AKI) is an important contributor towards morbidity and mortality among critically ill children. The objective of this study was to ascertain the etiological factors, categorize the severity and determine the immediate outcome of AKI among children admitted to the pediatric intensive care unit (PICU) of a tertiary referral hospital in south India.

Methods: A prospective study was conducted from January to December 2012 in the PICU, Government medical college, kozhikode, a major referral hospital in north Kerala. The institutional ethics committee approved the study. Children in the age group of 1 month to 12 years admitted to the PICU for at least 48 hours were included if they had no previous renal disease/AKI at the time of admission. Serum creatinine levels of the children were measured at the time of admission, at 48 hours, and one month later. Outcome measures included normalization of serum creatinine or persistence of impaired renal function. Mortality was assessed both immediately and after one month.

Results: A total of 1716 children were included in the study, of which 107 children developed AKI (6.2%). Among the 107 children, 56 children (52.3%) were boys. Majority of children were infants 75(70.1%). Infection was the commonest underlying condition   associated with AKI. Most of the children with acute kidney injury were in the earliest phase (Stage 1). Twenty-six children (24.29%) died. Among the survivors, 10% were found to have impaired renal function when followed up a month later.

Conclusions: There is a high incidence of AKI in critically ill infants admitted in PICU. Residual renal impairment can persist even after discharge from hospital and these children need follow up for a longer time.


Keywords


Acute kidney injury, Morbidity, Mortality, Paediatric intensive care unit

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References


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(3):183-9.

Fitzgerald JC, Basu RK, Akcan-Arikan A, Izquierdo LM, Piñeres BO, Hassinger AB, et al. Acute kidney injury in pediatric severe sepsis: An independent risk factor for death and new disability. Critical Care Med. 2016;44(12):2241-50.

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(7):537-42.

Hessey E, Morissette G, Lacroix J, Perreault S, Samuel S, Dorais M, et al. Long-term Mortality after acute kidney injury in the paediatric ICU. Hosp Pediatr. 2018;8(5):260-8.

Hessey E, Ali R, Dorais M, Morissette G, Pizzi M, Rink N et al. Renal function follow-up and renal recovery after acute kidney injury in critically ill children. Pediatr Crit Care Med. 2017;18(8):733-40.

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(2):R31.

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(9):526-9.

Ashraf M, Shahzad N, Hussain A, Tak SA, Bukhari ST, Kachru A. Incidence of pediatric acute kidney injury in hospitalized patients. Saudi J Kidney Dis Transpl. 2016; 27(6):1188-93.

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(3):129-33.

Krishnamurthy S, Narayanan P, Prabha S, Mondal N, Mahadevan S, Biswal N, et al. 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):207-13.

Gomez RA, Sequeira Lopez ML, Fernandez L, Cherñavvsky DR, Norwood VF. The maturing kidney: development and susceptibility. Ren Fail. 1999;21(3-4):283-91.

Shalaby MA, Sawan ZA, Nawawi E, Alsaedi S, Al-Wassia H, Kari JA. Incidence, risk factors, and outcome of neonatal acute kidney injury: a prospective cohort study. Pediatr Nephrol. 2018;33(9):1617-24.

Tresa V, Yaseen A, Lanewala AA, Hashmi S, Khatri S, et al. Etiology, clinical profile and short-term outcome of acute kidney injury in children at a tertiary care pediatric nephrology center in Pakistan. Ren Fail. 2017;39(1):26-31.

Nawaz S, Afzal K. Pediatric acute kidney injury in North India: A prospective hospital-based study. Saudi J Kidney Dis Transpl. 2018;29(3):689-97.