Clinico-etiological profile of acute kidney injury in children admitted to paediatric intensive care unit of a tertiary care centre

Background: Acute Kidney Injury (AKI) refers to a reversible accumulation of urea, creatinine and nitrogenous waste products and disturbances in maintenance of fluid and electrolyte homeostasis. The incidence of AKI continues to increase in the Paediatric age group particularly in critically ill children with the etiology shifting from primary renal disorders to multifactorial cause. The objective of the study to determine the incidence, clinical profile and outcome of AKI in critically ill children using p-RIFLE criteria.Methods: A prospective observational study was done with 342 children aged between 1-12 years, admitted in Paediatric Intensive Care Unit (PICU) of Institute of Child Health and Research Centre, Madurai Medical College, Madurai during July 2015 to June 2016.Results: The overall incidence of AKI among critically ill children was 30.1%. The mortality rate was 43.7% and 20.7% patients with AKI had partial renal recovery at the time of discharge. 27.2% patients required renal replacement therapy (RRT). Infectious causes 57.3% (Sepsis, Meningoencephalitis, Bronchopneumonia) dominated the etiological profile.Conclusions: Incidence of AKI is high in critically-ill children. AKI continues to be associated with adverse outcomes, including high mortality and partial renal recovery

A Study on Incidence, Clinical Profile and Outcome of Acute Kidney Injury in Children admitted to Paediatric Intensive Care Unit (PICU) of a Tertiary Care Centre

INTRODUCTION: Acute Kidney injury (AKI) is common in critically ill children, etiology of which is complex and multifactorial. AKI refers to kidney damage from mild injury to total loss of function that disrupts the homeostasis of fluid and electrolyte balances. Literary-texts show wide variations in incidence of AKI due to existence of multiple definitions. Three modern definitions are based on changes in serum creatinine and urine output are the RIFLE classification, the Acute Kidney Injury Network (AKIN) staging and Kidney Disease: Improving Global Outcomes (KDIGO) criteria. AIMS AND OBJECTIVES: 1. To determine the Incidence, clinical profile, outcome and predictors of mortality of Acute Kidney Injury in critically-ill children admitted to Paediatric Intensive Care Unit (PICU) of a Tertiary care centre. 2. To compare Acute Kidney Injury Network (AKIN) Staging and p-RIFLE classification in Paediatric age group. MATERIALS AND METHODS: A prospective observational study done in critically-ill children within 1 month – 12 years of age, admitted to PICU of our institute over a period of 1 year. Demographic information, admission/final diagnosis and co-morbidities, serial serum creatinine values, other hematological and metabolic parameters were collected. Urine output was measured 6th hourly. AKI was defined by AKIN staging and p-RIFLE classification. Outcome was measured as death, complete and partial renal recovery. RESULTS: The incidence of Acute Kidney Injury among critically ill children was 31% (AKIN staging) and 30.1% (p-RIFLE classification). The mortality rate was 42.5% and 19.7% patients with AKI had partial renal recovery at the time of discharge. 26.4% patients required renal replacement therapy (RRT). Infectious causes 56.6% (Sepsis, Meningoencephalitis, Bronchopneumonia) dominated the etiological profile. There was no difference between AKIN staging and p-RIFLE classification in identifying AKI cases from our study. Mechanical ventilation was found to be an independent predictor of mortality. CONCLUSION: Incidence of AKI is high in critically-ill children. AKI continues to be associated with adverse outcomes, including high mortality and partial renal recovery