Clinico-etiological profile of acute kidney injury in children admitted to paediatric intensive care unit of a tertiary care centre

Jakanattane V., Mathivanan M.


Background: Acute Kidney Injury (AKI) refers to a reversible accumulation of urea, creatinine and nitrogenous waste products and disturbances in maintenance of fluid and electrolyte homeostasis. The incidence of AKI continues to increase in the Paediatric age group particularly in critically ill children with the etiology shifting from primary renal disorders to multifactorial cause. The objective of the study to determine the incidence, clinical profile and outcome of AKI in critically ill children using p-RIFLE criteria.

Methods: A prospective observational study was done with 342 children aged between 1-12 years, admitted in Paediatric Intensive Care Unit (PICU) of Institute of Child Health and Research Centre, Madurai Medical College, Madurai during July 2015 to June 2016.

Results: The overall incidence of AKI among critically ill children was 30.1%. The mortality rate was 43.7% and 20.7% patients with AKI had partial renal recovery at the time of discharge. 27.2% patients required renal replacement therapy (RRT). Infectious causes 57.3% (Sepsis, Meningoencephalitis, Bronchopneumonia) dominated the etiological profile.

Conclusions: Incidence of AKI is high in critically-ill children. AKI continues to be associated with adverse outcomes, including high mortality and partial renal recovery.


Acute Kidney Injury, PICU children, p-RIFLE criteria

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Andreoli SP. Acute kidney injury in children. Pediatr Nephrol. 2009 Feb;24(2):253-63.

Basu RK, Devarajan P, Wong H, Wheeler DS. An update and review of acute kidney injury in pediatrics. Pediatr Crit Care Med. 2011 May;12(3):339-47.

Schneider J, Khemani R, Grushkin C et al. Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and1length of stay for children in the pediatric intensive care unit. CritCareMed 2010; 38: 933–939

Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. [Consensus Development Conference Guideline Practice Guideline Review]. 2004 Aug;8(4):R204-12.

Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney international. [Research Support, Non-U.S. Gov't]. 2007 May;71(10):1028-35.

Mehta RL, Kellum JA, Shah SV et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11: R31.

Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney InjuryWork Group: KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Inter Suppl 2012, 2:1–138.

Sriram Krishnamurthy, NiveditaMondal, Parameswaran Narayanan, Niranjan Biswal, Sadagopan Srinivasan, Rajendiran Soundravally. Incidence and etiology of acute kidney injury in southern India. Indian J Pediatr 2012 online publication.

Poonam Mehta, Aditi Sinha, Abdus Sami, Pankaj Hari, Mani Kalaivani, Ashima Gulati, Madhulika Kabra, Sushil K Kabra, Rakesh Lodha and Arvind Bagga from the Departments of Pediatrics and Biostatistics, All India Institute of Medical Sciences, New Delhi, India; 2011.

Srivastava RN, Bagga A, Moudgil A. Acute renal failure in north Indian children. Indian J Med Res.1990;92:404–8.

Muntner P, Warnock DG. Acute kidney injury in sepsis: Questions answered, but others remain. Kidney Int. 2010;77:485–7.

Study of Acute Kidney Injury in children; Its aetiology, clinical profile and outcome; Garuda Ram, Journal of Evidence based Medicine and Healthcare; Vol 2, Issue 11, March 16, 2015.

Sinha R, Nandi M, Tullus K, Marks SD, Taraphder A. Ten-year follow-up of children after acute renal failure from a developing country. Nephrol Dial Transplant. 2009;24:829–33

Ghani AA, Al Helal B, Hussain N. Acute renal failure in pediatric patients: Etiology and predictors of outcome. Saudi J Kidney Dis Transpl. 2009;20:69–76.

Vachvanichsanong P, Dissaneewate P, Lim A, McNeil E. Childhood acute renal failure: 22-year experience in a university hospital in southern Thailand. Pediatrics. 2006;118:e786–91.

Acute kidney injury in critically ill children; risk factors and outcome, Indian Journal of Critical Care Medicine, March 2014 Vol 18 Issue 3, Shweta naik, Jyoti Sharma, Rameshwar yengkom, Vijay Kalroa, Atul Mulay.

"K/Doqi Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification," 2002.

A comparison of pRIFLE and AKIN criteria for acute kidney injury in pediatric intensive care unit patients; International Journal of Contemporary Pediatrics 2016 May;3(2):398-402 Srinivasa S., Reshmavathi V., Srividya G. S., Dept of Paediatrics, Kempegowda Institute of Medical Sciences.