Ramdass, K (2012) A Study on Clinical Profile and Reversible Risk Factors Associated with Poor Outcome in Acute Kidney Injury. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Acute Kidney Injury (AKI), the new term heralds a paradigm shift for our conceptualization of the syndrome which is previously called “acute renal failure.” AKI retains one word, substitutes a synonym for another, but supplants “failure” with “injury.” This substitution may very well redefine the epidemiology of the syndrome. Acute renal failure (ARF), now increasingly referred to as “acute kidney injury” or AKI, which is characterized by a abrupt (ie., hours to days) impairment of kidney function. The current perception of AKI has evolved along with developments in pathology and clinical biochemistry that have permitted clinicopathologic correlations and early diagnosis3. Initial delineation of AKI from the early 20th century centered around specific conditions such as war nephritis5 , crush injuries4,and falciparum malaria6.In 1912, Sir William Osler7 described several recognizable causes of AKI under the heading of “acute Bright’s disease,” including toxins, burns, pregnancy, and sepsis. AKI is now inferred to be an increasingly common and potentially disastrous complication in hospitalized patients. AIM OF STUDY: This study aims at finding out the clinical profile and reversible(modifiable) risk factors associated with poor outcome in children with acute kidney injury seen in this part of the country in a referral pediatric centre at Chennai. DISCUSSION: In our study, the maximum number of cases of acute kidney injury were under 1 year age group accounting 37% of total children. This is because of increased incidence of sepsis in this age group. Next major group was noted in 4-8 years age group with 28% of total children. With regard to the sex distribution, the females are predominantly affected when compared to males. This fact of female predominance is consistent with ICH scenario of ARF cases in the year 2008 (male : female ratio 1:2).Whereas the study conducted by Gallego et al., showed that there is no sex predilection among the ARF cases and also contrary to the observation by Arora et al., which showed male predominance . A.K.I can occur due to number of causes. Significant portion being acute glomerulonephritis, acute tubular necrosis following diarrhoeal dehydration ,posterior urethral valves, Post surgical etc., In our study ,sepsis is the leading cause of A.K.I. It differs from the study conducted by B.V. Singh et al., His study showed that Acute glomerulo nephritis is commonest. Our study showed that next to sepsis, diarrholeal dehydration and A.G.N were common. In study conducted by Arora et al., showed haemolytic uremic syndrome as the commonest cause of A.K.I. Patrick Niaudet et al., also showed that haemolytic uremic syndrome as the commonest cause of A.R.F. which he attributed mostly due to the precipitating factor like diarrhoea and high incidence of H.U.S may be probably due to poor socio economic conditions and poor sanitary facilities, leading on to diarrhoea . H.U.S is a cause of A.K.I only in less than 5% of cases in our study. This is because of recognition of complication earlier and efficient treatment of acute watery diarrhoea .Besides that delayed referral increases the mortality rate. H.U.S was found to be a bad prognosticator by R.S Trompeter , he gave a mortality of 30% .In our study one child expired out of three children affected with haemolytic uremic syndrome. CONCLUSION: 1.Acute kidney injury is one of the important causes of morbidity and mortality in children. 2.Female predominance with a male : female ratio 1:1.4 is observed. 3.Sepsis is the commonest cause of acute kidney injury in children. Other common causes of acute kidney injury in children are acute gastro enteritis, acute glomrulonephritis. 4.Overall mortality rate of acute kidney injury in children aged between 1 month to 12 years noted was 43%.In male children mortality rate was 45.3%and in female children it was 41.4%. 5.Non oliguric AKI is usually diagnosed by high index suspicion and by periodic biochemical monitoring. 6.Mortality among non oliguric AKI patients was due to septicaemia. 7. Risk factors associated with poor outcome were, anuria, bleeding, shock, hypotension,hypertension, sepsis, AGN, high blood urea, serum creatinine values. 8.Clinically, predictive factors for poor outcome in acute kidney injury found were anuria, shock, hypotension. Hence extra attention should be given for these cases in future to reduce the mortality. 9. Significant reversible factors of acute kidney injury observed were dehydration , sepsis, shock . 10. Hence,prevention or early diagnosis and treatment of these factors will improve the outcome.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Clinical Profile; Reversible Risk Factors ; Associated ; Poor Outcome ; Acute Kidney Injury |
| Subjects: | MEDICAL > Paediatrics |
| Depositing User: | Ravindran C |
| Date Deposited: | 16 Apr 2018 06:34 |
| Last Modified: | 16 Apr 2018 06:34 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7004 |
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