Etiology, Risk Factors and Outcome of AKI in a Medical Intensive Care Unit: A Longitudinal Descriptive study

Navaneetharan, K (2020) Etiology, Risk Factors and Outcome of AKI in a Medical Intensive Care Unit: A Longitudinal Descriptive study. Masters thesis, PSG Institute of Medical Sciences and Research, Coimbatore.


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INTRODUCTION: Acute Kidney Injury (AKI) is a common and a serious complication among patients admitted to intensive care units (ICUs), and has been the focus of many studies leading to recent advances in diagnosis and classification. AKI, previously known as acute renal failure, is characterized by the sudden impairment of kidney function resulting in the retention of nitrogenous and other waste products normally cleared by the kidneys. AKI is not a single disease but, rather, a designation for a heterogeneous group of conditions that share common diagnostic features: specifically, an increase in the blood urea nitrogen (BUN) concentration and/or an increase in the plasma or serum creatinine concentration often associated with a reduction in urine volume. It is important to recognize that AKI is a clinical diagnosis and not a structural one. A patient may have AKI without injury to the kidney parenchyma. AKI can range in severity from asymptomatic and transient changes in laboratory parameters of glomerular filtration rate (GFR), to overwhelming and rapidly fatal derangement in effective circulating volume regulation and electrolyte and acid-base composition of the plasma. AIM OF THE STUDY: To study the etiology, risk factor and outcome of AKI in Medical Intensive care Unit. Objectives: Primary- To evaluate the etiological spectrum of AKI in patients admitted to a medical intensive care unit(MICU) in a tertiary medical care centre. Secondary- 1. To describe risk factors for the development of AKI in a population of medical intensive care unit (MICU) patients. 2. To evaluate the severity and outcome of AKI in a population of medical intensive care unit (MICU) patients METHODOLOGY: Hospital based Single centre longitudinal observational study done on Patients aged >18 diagnosed as AKI on admission to MICU or who develop AKI during the MICU stay, meeting the inclusion criteria, during the study period. Inclusion Criteria: Admitted in MICU with AKI/ Develops AKI during MICU stay and Age >18 years. Exclusion Criteria: 1. Pre-existing Renal Disease. 2. Post- Renal Transplant. RESULTS: 49% of the patients had infectious etiology, 17% of people were admitted for pulmonary causes, 16% were admitted with a cardiac cause, 10% were admitted for a primary gastrointestinal pathology, 4% of people were admitted with a primary neurological disease. 61% of people had complete recovery with their creatinine returning to normal range, 13% had progressed to CKD, 26% were dead. Hypertension(p value -0.034) and albuminuria (p-0.015) were associated with worse outcomes. Similarly exposure to nephrotoxic drugs were associated with worse outcomes(p-0.03). There was an association between patients who were dialysed and a poor clinical outcome. CONCLUSION: Infection related etiology is the most common among the AKI patients, underlying hypertension, proteinuria and nephrotoxin exposure to have statistically significant association with a worse outcome and that the case fatality rate was nearly 26% and that around 13% of people who had developed AKI had progressed to CKD.

Item Type: Thesis (Masters)
Additional Information: 201711503
Uncontrolled Keywords: Acute Kidney Injury (AKI), Etiology, Risk Factors, Outcome, Intensive care.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 28 Jan 2021 19:17
Last Modified: 30 Jan 2021 14:35

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