Acute Kidney Injury in the Tropics

The epidemiological pattern of acute kidney injury (AKI) in tropical countries during monsoon reflects infectious disease as the most important cause. AKI is a confounding factor and may be overlooked by primary health-care providers and underreported in health statistics. The present study prospectively helps estimate the burden of disease and analyze etiology, clinical profile, and outcome in a tertiary care hospital of a metropolitan city in a tropical country. The study period included monsoon season of 2012 and 2013, a total of 8 months. AKI staging was done as per the AKI Network (AKIN) criteria. Patients were treated for primary disease. Renal replacement therapy (RRT) was given as required. Patients were followed up during hospitalization till recovery/death. Out of a total of 9930 admissions during this period, 1740 (17.52%) were for infections and 230 (2.31%) had AKI secondary to infectious diseases during monsoon. The incidence of AKI (230/1740) in infectious diseases during monsoon was 13.21%. The study population (n = 230) comprised 79.5% of males and the mean age was 40.95 ± 16.55 years. Severe AKI: AKIN Stage III was seen in 48.26% of patients and AKIN Stage I in 41.74%. The most common etiology of AKI was malaria (28.3%) followed by acute gastroenteritis (23%), dengue (16.5%), leptospirosis (13%), undifferentiated fever (10.4%), more than one etiology (5.4%), and enteric fever (3.5%). RRT was required in 44.78% of patients. Requirement for RRT was maximum in patients with more than one etiology followed by leptospirosis, malaria, dengue, and least in typhoid. The overall mortality was 12.17%. In multivariate analysis, vasopressor support and assisted ventilation were risk factors for mortality.

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“…The severity of acute kidney injury was defined by the Acute Kidney Injury Network staging criteria as follows[ 9 ]…”

Section: Methodsmentioning

confidence: 99%

Acute kidney injury of infectious etiology in monsoon season: A prospective study using acute kidney injury network criteria

et al. 2018

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“…Kidneys being the main organ of excretion, a combination of high blood flow and large surface area of the kidneys increase the susceptibility of the renal parenchyma leading to various complications. The causes of renal failure in tropical Asia is mainly from poisons and toxins of local flora and fauna or other chemical sources (Burdmann et al 2010).…”

Section: Discussionmentioning

confidence: 99%

Acute Renal Failure in Acute Poisoning: Prospective Study From a Tertiary Care Centre of South India

Shah¹,

Meenakshisundaram²,

Sakthirajan

et al. 2011

Journal of Renal Care

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“…[2] An incidence of renal involvement with snakebite envenomation of 1.4–28% has been reported in various series,[3] and incidence of ARF is 10–32%. [456] Among multifactorial cause for the pathogenesis of snakebite-induced AKI (SAKI), elevated oxidative, and carbonyl stress (CS) leading cause of kidney injury. [78] Oxidative stress (OS) results in the modification of protein either directly through the oxidation of amino acid residues by reactive oxygen species (ROS) or indirectly by an increased generation of reactive carbonyl species [Figure 1].…”

Section: Introductionmentioning

confidence: 99%

Snakebite mediated acute kidney injury, prognostic predictors, oxidative and carbonyl stress: A prospective study

et al. 2016

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Snake bite is an occupational hazard in India and important preventable cause of acute kidney injury (AKI). This study was done to estimate the magnitude of snakebite-induced AKI (SAKI) who required renal replacement therapy, prognostic predictors, and final outcome, and to measure the oxidative and carbonyl stress (CS) level in SAKI patient who underwent hemodialysis (HD). All SAKI patients dialyzed between April 2010 and July 2011 in NRS Medical College were included. Demographical, clinical, and biochemical data were analyzed, and patients are followed to discharge or death. Oxidative and CS markers (advanced oxidation protein product [AOPP], advanced glycation end product, pentosidine, dityrosine, thioberbituric acid reactive substance, and methylglyoxal [MG]) were measured in 48 SAKI patient requiring HD. About 155 SAKI patients (M: F 2.2:1) received HD. Of them. The age was 36.2 (range 4–74) years. The most common site of the bite was lower limb (88.7%). Oliguria and bleeding manifestation were the common presentation. Hypotension was found in 52 (33.5%) cases, cellulitis and inflammation were found in about 63%. Mean creatinine was 4.56 ± 0.24 mg/dl. About 42 (27.1%) had disseminated intravascular coagulation (DIC). 36 (78.2%) had cellulites, 24 (52.2%) had hypotension or shock at initial presentation (P < 0.05), bleeding manifestation was found in 37 (80.4%), and 22 (47.8%) had DIC (P < 0.05). Forty-six (29.7%) patient died. DIC and hypotension/shock at initial presentation came out as an independent predictor of death. Among all markers measured for oxidative and CS (n = 48) AOPP and MG came out as an independent predictor (P < 0.05) of adverse outcome. Hypotension, DIC, AOPP, and MG were a poor prognostic marker in SAKI patients requiring dialysis.

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Acute Kidney Injury in the Tropics

Cited by 3 publications

References 22 publications

Acute kidney injury of infectious etiology in monsoon season: A prospective study using acute kidney injury network criteria

Acute kidney injury of infectious etiology in monsoon season: A prospective study using acute kidney injury network criteria

Acute Renal Failure in Acute Poisoning: Prospective Study From a Tertiary Care Centre of South India

Snakebite mediated acute kidney injury, prognostic predictors, oxidative and carbonyl stress: A prospective study

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