Acute Kidney Injury in Acute Febrile Illness.

Pratish Jacob, George (2011) Acute Kidney Injury in Acute Febrile Illness. Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION : Acute renal failure has dominated the attention of Nephrologists for decades, with focused research aiming at reducing the morbidity and mortality related to the entity. Despite advances in diagnostics, management and dialysis related interventions the results have been disappointing with no significant mortality differences in last five decades. The importance of this quest to reduce mortality and renal morbidity is amplified by the fact that 60% critically ill patients die during hospitalization and 13% of the survivors become dialysis dependent. In patients who recover from acute renal failure after variable periods of renal replacement therapy, renal insufficiency is observed in 41% and five year survival is about 50%. This puts an additional burden on health infrastructure and economy. AIM : To study the clinical features, prognosis and outcomes of acute kidney injury (AKI) in patients presenting with scrub typhus, malaria, dengue fever, typhoid, leptospirosis and undifferentiated fever particularly to identify patients at high risk of developing AKI and mortality related to AFI, aiming to identify mechanisms for effective management using the RIFLE criteria and testing the utility of Cystatin C as a biomarker for diagnosis of AKI. PATIENTS AND METHODS : Consecutive in-patients with AFI were enrolled prospectively after admission to a tertiary care referral hospital. They were studied based on etiology of AFI. AKI in these patients was investigated and graded using the RIFLE criteria. Their presentation and course during hospital stay was studied to estimate morbidity, severity of AKI, dialysis requirement, mortality and evaluated for prognostic indicators. RESULTS : 163 patients were enrolled in the study and 136 patients were studied based on inclusion criteria. The mean age was 40.9 ± 15.6 (16 to 77 years) and sex ratio 2:1 (male 91: female 45). AKI was observed in 71.3% and was graded using the RIFLE criteria as Risk (R) in 19.9%, Injury (I) in 15.4% and Failure (F) in 36%. 10 (7.4%) patients had hospital associated AKI. Undifferentiated fever had the highest incidence of AKI (94.7%) with dialysis requirement in 26.3% and death in 52.6%, while in the differentiated fevers AKI was commonest in malarial infection by P. falciparum (100%). Maximum dialysis requirement was noted in in mixed malarial infection (27.8%) and highest mortality in dengue fever (42.7%). Overall 26.5% patients died during hospital stay with 33% mortality in AKI as compared to 10.3% in the non AKI group. RIFLE criteria was identified as a sensitive tool for diagnosis of AKI in AFI and patients have worse prognosis and outcomes from R through I and F stages in terms of organ support, dialysis requirement and death. RIFLE staging using Cystatin C appears to be sensitive in diagnosing AKI in AFI earlier and may be a useful adjunct for early management. Fractional excretion of sodium (FENa) was useful in identifying early AKI. The Liano scoring at admission identified high risk patients and may be useful for triage to high dependency care. Renal Failure Index (RFI) was higher in those who underwent dialysis and died. Hemodialysis was initiated in 18.4% of whom 48% required SLED. Mortality in patients initiated on hemodialysis was 64% with 100% mortality in those requiring SLED. CONCLUSION : AKI has a high incidence in AFI. Application of the RIFLE criteria shows incremental risk for morbidity, dialysis requirement and mortality. Patients requiring hemodialysis have high mortality. Cystatin C has promise as a biomarker for early identification and management of AKI in AFI.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Acute Kidney Injury ; Acute Febrile Illness.
Subjects: MEDICAL > Nephrology
Depositing User: Kambaraman B
Date Deposited: 11 Jul 2017 07:38
Last Modified: 11 Jul 2017 07:38

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