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Incidence and Etiology of Acute Kidney Injury in Children Admitted to PICU using PRIFLE Criteria

Introduction: Acute Kidney Injury (AKI) is associated with severe morbidity and mortality. Lack of consensus definition has been major limitation in improving outcomes. Acute Dialysis Quality Initiative Group (ADQI) group proposed RIFLE (Risk, Injury, Failure, Loss of function, End stage renal disease) criteria, criteria for defining AKI, later modified in children as pRIFLE (pediatric RIFLE). This study tries to address the need of limited data on pediatric AKI.
Methodology: A prospective study conducted in between December 2013 to May 2015. Serum creatinine level was estimated on all patients on admission and alternate days till discharge from Pediatric Intensive Care Unit (PICU). Urine output was recorded. Estimated Creatinine- Clearance (eCrCL) was calculated using Schwartz formula. AKI diagnosis and staging was based on pRIFLE (pediatric RIFLE) criteria. Either eCrCl or urine output criteria were used to diagnose and stage AKI, using criterion that leads to higher stage. Maximal stage that the patient progressed during the stay in PICU was assigned the stage for that case. Data was compiled using SPSS software.
Results: Of total 697 cases, 680 cases met inclusion criteria. Incidence of AKI was 178 (26.1%). Stage ‘Risk (R)’, ‘Injury (I)’ and ‘Failure (F)’ constituted 60.7% (108), 28.6% (51) and 10.6% (19) respectively. Maximum AKI occurred in < 1 year (28.1%) (p=0.003). Urine output and creatinine criteria matching were there in 77%. Infections were commonest etiology. Amongst infections dengue (30%) was most common, followed by sepsis (21.9%) and then pneumonia (17.9%). Hypotension, nephrotoxic drugs, sepsis, need for mechanical ventilation were significant (p<0.001) risk factors for AKI. Prerenal causes constituted 68% and renal 32%.
Conclusion: Incidence of AKI is high among critically ill children. pRIFLE staging system that provides early identification and stratification of AKI. Infections are leading etiology of AKI in children.

Author(s): Srinivasa S, Reshmavathi V