Clinical profile and outcome of acute kidney injury in neonatal sepsis in a tertiary care centre

Abstract

Original Research ArticleClinical profile and outcome of acute kidney injury in neonatal sepsis in a tertiary care centre Divya Durga*, Sudha Rudrappa INTRODUCTIONNeonatal sepsis is one of the major global health problems. Thirty eight percent of all childhood deaths occur in neonates 1 . Ninety nine percent of these neonatal deaths occur in low-income and middle-income countries.1 In developing countries like India, sepsis contributes to 37% of all neonatal deaths.2 As per the National Neonatal Perinatal Database (NNPD) 2002 -2003, the incidence of neonatal sepsis is 30 per 1000 live births3. Sepsis affects many important organs of the body leading to multiple organ dysfunction syndrome (MODS) of which kidney is one of the most important organs to be affected.Acute renal failure (ARF) is characterized by sudden (within 48 hours) impairment in kidney function that results in the retention of nitrogenous waste products, e.g. ABSTRACTBackground: Septicemia remains a leading cause of morbidity and mortality among neonates with AKI complicating as many as 3.4 to 24% of them. The actual incidence of renal failure in all sepsis cases is not documented. There are several studies in the literature on renal failure in neonates which were based on older definitions using blood urea and urine output as parameters. The major limitation of the older studies was that they did not use the current acute kidney injury network (AKIN) definition. In the present study, we have attempted to investigate AKI in neonatal sepsis using the AKIN definition based on serum creatinine (Table1). We also attempted to determine the predictors of AKI in neonatal sepsis. Methods: The present study was an explorative study conducted in the neonatal unit of Cheluvamba hospital attached to Mysore Medical College and Research Institute in which a total of 50 neonates with clinical/ culture positive sepsis were enrolled during the period of June 2014 to June 2015. Results: These neonates were investigated for the presence of AKI based on serum creatinine values of three consecutive days and were divided into two groups. Group 1 consisted of septic neonates with AKI and group 2 consisted of septic neonates without AKI. Both the groups were followed up till discharge or death. The risk factors associated with sepsis were compared in both the groups and predictors of morbidity and mortality associated with AKI in sepsis were also determined. Conclusions: Incidence and mortality associated with AKI in sepsis was found to be 24% and 75% respectively. Factors like PROM, foul smelling liquor, > 3 unclean vaginal examinations during labour were significant risk factors for development of AKI in sepsis. Culture positivity, associated meningitis, DIC, shock and need for assisted ventilation were poor prognostic indicators and were significantly associated with mortality.

Correlation of renal function tests with early onset neonatal sepsis.

“…Total number of septic neonates enrolled were less (only 50) as compared to our study. 21 Gaurav et al in their study in India showed 21.49% (34 out of 107) septic neonates developed acute renal failure. This is slightly lower percentage than our value as number of patients in their study was less as compared to our study.…”

Clinical profile of neonates with acute renal injury in neonatal intensive care unit at GMERS Medical College and General Hospital, Gotri, Vadodara, Gujarat, India

“…Sepsis has been consistently associated as a risk factor for development of AKI in various studies conducted around the world contributing to as high as 78% cases in some neonatal studies. 28 Another study from India by Mathur NB et al, shows that out of 200 newborns with sepsis, 26% developed AKI. 29 The newborns with sepsis are thought to be predisposed for AKI as a result of hypotension secondary to sepsis and a direct damaging effect on renal microvasculature.…”