Etiology, Clinical Profile, and Short-Term Outcome of Children With Acute Kidney Injury

Abstract

Background: Acute kidney injury (AKI) is a common clinical syndrome in hospitalized children and it imposes heavy burden of mortality and morbidity. In resource-constraint settings, management of AKI is very challenging and associated with adverse outcomes. The aim of this study was to determine the clinicoetiological profile and outcome of AKI.Methodology: This prospective observational study was done at the department of pediatric nephrology and pediatric intensive care unit, National Institute of Child Health, Karachi, Pakistan from December 2020 to May 2021. A total of 130 children aged 1 month to 15 years, diagnosed with AKI irrespective of the underlying cause were included. Detailed medical information of each child including medical history, examination, and baseline investigations were obtained. Clinical and etiological profile of patients was noted. The patients were followed up to three months and the outcome was noted.Results: In a total of 130 children, 82 (63.1%) were male. The mean age was 5.5±4.4 years (ranging between 1 month and 15 years). There were 117 (90.0%) children who were referred from other centers for either dialysis or surgical treatment. Prerenal cause of AKI was found in 66 (50.8%) children, followed by renal 53 (40.8%) and postrenal in 11 (8.5%) cases. Fever and shortness of breath were the most common clinical presenting symptoms in 102 (78.5%) and 100 (76%) cases, respectively. There were 45 (34.6%) cases who were managed conservatively, 80 (61.5%) needed dialysis, while three children were managed with plasmapheresis and two required surgical intervention in the emergency department. At threemonth follow-up period, 64 (49.2%) children recovered (including nine with partial recovery), 46 (36.1%) expired, 9 (6.9%) developed end-stage renal disease, while 11 (8.5%) had chronic kidney disease. Conclusion: Sepsis, nephrotoxic drugs, and acute glomerulonephritis were the major causes of AKI at our center. Mortality was high among children presenting with AKI. A relatively high proportion of children with younger age, septic AKI, and presentation in critical condition could be the reasons for this high mortality.

Pattern and prognostic factors for kidney function progression in survivors of children with acute kidney injury: a cohort study

“…The incidence of AKD in our cohort was higher than the reported incidence 13 14 20–22. This discrepancy could be attributed to the fact that 28.1% of children did not have follow-up SCr levels, and these children may have relatively uncomplicated conditions with a lower risk of developing AKD.…”

The pattern and prognostic factors for kidney function progression in children with acute kidney injury and acute kidney disease

“…The incidence of AKD in our cohort was higher than the reported incidences [14,15,23,24,25]. Our finding could be partly explained by that 28.1% of children did not have a follow-up SCr level to determine the AKD status, and they may comprise patients with relatively stable and simple conditions that had a lower risk of developing AKD.…”

“…While the association between AKI and short-term kidney outcomes has been consistently demonstrated [14,15,23,24,25,28], the impact of AKD on kidney outcomes in children has been less described. Deng et al showed that among 990 hospitalized children with AKI, those with stage 2/3 AKD carried an increased risk of MAKE30 and 90-day adverse outcomes (including mortality or chronic dialysis) [24].…”

Aetiologies clinical presentation and outcome of acute kidney injury in children aged 29 days to 5 years: a two-year retrospective study

“…Anaemia on the other hand may be associated with the aetiological factor associated with AKI, which was malaria in 31.48% of the cases. Bai et al reported a similar prevalence of fever (78.5%), anuria/oliguria (53.1%), and anaemia (52.3%) in Pakistan children in 2021 [20].…”

“…This is coupled with scarce means of paediatric dialysis, which reduces the accessibility to every population with severe forms of AKI, resulting in a high mortality rate [17,22]. Younger children are known to be more vulnerable and there are limited options of diagnosis and treatment [19,20]. Treatment options available are often not adapted and sometimes do not exist [14].…”