Acute kidney injury in dengue virus infection

Abstract

BackgroundDengue is a growing public health problem in Pakistan and acute kidney injury (AKI) is one of the least studied complications of dengue virus infection (DVI). The aim of this study was to determine the frequency, severity and predictors of AKI in patients with DVI and to study the impact of AKI on the length of hospital stay and mortality.MethodsWe retrospectively reviewed medical records of patients aged ≥14 years hospitalized with a primary diagnosis of DVI at Aga Khan University Hospital Karachi between January 2008 and December 2010. Binary logistic regression models were constructed to identify factors associated with the development of AKI and to study the impact of AKI on hospital stays of more than 3 days.ResultsOut of 532 patients, AKI was present in 13.3% (71/532). Approximately two-thirds (64.8%) of these patients had mild AKI and a third (35.2%) had moderate to severe AKI. Independent predictors for AKI were male gender [odds ratio (OD) 4.43; 95% CI 1.92–10.23], presence of dengue hemorrhagic and dengue shock syndrome (DSS, OD 2.14; 95% CI 1.06–4.32), neurological involvement (OD 12.08; 95% CI 2.82–51.77) and prolonged activated partial thromboplastin time (aPTT, OD 1.81; 95% CI 1.003–3.26). AKI was associated with a length of stay ≥3 days when compared with those who did not have AKI (OD 2.98; 95% CI 1.66–5.34). Eight patients (11.3%) with AKI died whereas there were no mortalities in patients without AKI (P < 0.001). Only 5 patients (7%) had persistent kidney dysfunction at discharge.ConclusionsAKI in DVI is associated with neurological involvement, prolongation of aPTT, greater length of hospital stay and increased mortality.

Defining acute kidney injury in dengue viral infection by conventional and novel classification systems (AKIN and RIFLE): a comparative analysis

“…In this regard, when the AKIN classification was evaluated, the incidence of AKI ranged from 10.8% to 13.3%5 6 while, with CD, the incidence varied between 0.9% and 3.3% 3 4. We found two studies evaluating the incidence of AKI using the RIFLE criteria that reported a much higher incidence than our study 13 14.…”

“…The probability of developing AKI in dengue infection varies from 0.9% to 13.3% according to the diagnostic criteria adopted and the severity of the dengue infection—that is, dengue fever (DF), dengue haemorrhagic fever (DHF) or dengue shock syndrome (DSS) 3–6. The reported incidence of AKI is 0.9%3 and 3.3%4 in DHF/DSS, while the incidence of AKI has been reported to be 10.8%5 and 13.3%6 in all types of dengue infection, irrespective of severity. The development of AKI has a significant impact on the outcome of patients with dengue infection, with mortality estimated at 11.3–64% and a longer hospital stay 3 4 6.…”

“…The reported incidence of AKI is 0.9%3 and 3.3%4 in DHF/DSS, while the incidence of AKI has been reported to be 10.8%5 and 13.3%6 in all types of dengue infection, irrespective of severity. The development of AKI has a significant impact on the outcome of patients with dengue infection, with mortality estimated at 11.3–64% and a longer hospital stay 3 4 6. It is interesting to note that even small increases in serum creatinine (SCr) are significantly associated with mortality 7.…”

“…To date, AKI in dengue infection has been defined by a conventional definition (CD) (SCr >2 mg/dL),3 4 the AKIN5 6 or RIFLE13 14 classifications, but the rapidly fluctuating incidence of AKI in dengue infection from 0.9%3 to 13.3%6 indicates an urgent need for consensus in identifying AKI in dengue infection. Moreover, the RIFLE classification has not been properly validated in patients with dengue.…”

Effect of dengue virus infection on the permeability of vero cells line

“…Recent finding that uses epithelial cells as the target cells for dengue virus also satisfy to the previous research that reported the increase of porcine renal cell line LLC-PK1 when exposed to TNF-α, one of the cytokine that released by epithelial cells in response to dengue infection [14]. The evidence of the increase of the permeability of monkey kidney in response to dengue infection as found in the recent study may help to explain why the mortality of dengue patients with acute kidney injury was higher than those without kidney injury as reported by previous researchs [15,16,17].…”