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Year : 2021  |  Volume : 6  |  Issue : 1  |  Page : 13-20

Prevalence and outcome of severe acute kidney injury in children in a critical care nephrology unit

Department of Pediatric Nephrology, Bangladesh Institute of Child Health & Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh

Correspondence Address:
Professor Dr. Shireen Afroz
Department of Pediatric Nephrology, Bangladesh Institute of Child Health & Dhaka Shishu (Children) Hospital, Sher E Bangla Nagar, Dhaka 1207
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/pnjb.pnjb_3_21

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Background: This prospective observational study was conducted to see the prevalence, etiology, clinical profile, and immediate outcome of community-acquired acute kidney injury (AKI) in a pediatric critical care nephrology setup in Bangladesh. Materials and Methods: The prevalence, etiology, outcome, and fatality predictors of critically ill children with AKI, aged 5 days to 17 years from January 2016 to June 2018 were studied at Dhaka Shishu (Children) Hospital, Bangladesh. AKIN criteria were used to screen AKI. They were given supportive care and dialysis. Results: The prevalence of AKI among 725 patients was 61%. All the AKI cases were at AKIN stage III. Pre-renal cause accounted for 63%, renal 19% and post-renal 18%. The most common etiology of pre-renal AKI was post-diarrheal hypovolemia (50%), renal cause of AKI includes glomerulonephritis (45%) and among post-renal cause posterior urethral valves was 78%. Hypovolemia and shock were found in 12% of cases. Congestive cardiac failure (10%), hypertensive crisis (7%), severe hypernatremia (24%), severe metabolic acidosis (11%), and dialysis requirement (76%) were found to be associated with the worst outcome. Fifty-one percent improved with normal renal function. Of 441 AKI cases, 201 (46%) improved and among them 102 (51%) regained with normal renal functions. Approximately 99 (49%) with partial renal recovery and most (41) of them were due to renal cause of AKI. The overall worst outcome was observed in 54% and mortality in 40%. The highest mortality was found among neonates (60%) and infants (41%). Glasgow coma scale was <3 in 16% cases. Need for mechanical ventilation (11%) and longer hospital stay >30 days (9%) were the important predictors of fatality in AKI. Conclusion: Higher prevalence of severe AKI was associated with high mortality in neonates and infants in critical-care setup. Longer hospital stay and need for dialysis and mechanical ventilator predicted worst outcome.

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