Abstrakt

Prevalence and outcome of acute kidney injury in dengue patients in a tertiary care hospital, India

Jaiju James Chakola

Dengue is a growing public health problem and AKI is one of the major complications of dengue virus infection. A total of 922 dengue patients were retrospectively evaluated and were stratified into AKI and non-AKI groups. Two groups were compared using appropriate statistical methods. There were 103 patients (11.2%) who had AKI, with AKIN-I, II and III in 68.8%, 23.6% and 7.6% patients, respectively. Significant differences (P<0.05) in demographics and clinic-laboratory characteristics were observed between patients with and without AKI. Presence of DHF [OR (95% CI): 8.0 ( P<0.001], rhabdomyolysis [OR (95% CI): 7.9 ,MODS [OR (95% CI): 34.6 [P<0.001], diabetes mellitus [OR (95% CI): 4.7, P=0.034], late hospitalization [OR (95% CI): 2.1 ,P=0.033] and use of nephrotoxic drugs [OR (95% CI): 2.9 P=0.006] were associated with AKI. Longer hospital stays (>7 days) was also observed among AKI patients (OR=1.3, P=0.044). Additionally, 24.5% AKI patients had renal insufficiencies at discharge that were significantly associated with severe dengue. Overall mortality was 1.8% and all fatal cases had AKI. The incidence of AKI is high at 11.2% among dengue patients, and those with AKI portended significant morbidity, mortality, longer hospital stays and poor renal outcomes. Dengue viral infection has emerged as one of the most common arthropod borne diseases and is more prevalent in the tropical countries. It has varied clinical spectrum ranging from undifferentiated fever to severe hemorrhagic fever and shock with multi-organ dysfunction. Acute kidney injury (AKI) is lesser known complication in DVI. Although studies report varying reports of AKI in DVI among children, exact incidence is not known as most of the studies are retrospective. Hospital-based observational study in 105 children with DVI requiring admission was studied for the occurrence of AKI along with clinical course and outcome. AKI Network (AKIN) criteria were used to define AKI. The IBM SPSS Statistics software version 21.0 was used for the statistical analysis. Of 105 children with dengue, six (5.71%) cases developed AKI. All six cases had urine output <0.5 mL/kg/h for ≥12 h. Out of six cases with AKI, four had raised serum creatinine (SCr) ≥0.3 mg/dL at admission. One child had normal SCr level at admission which got deranged over the next 12 h, one child had oliguria ( <0.5 mL/kg/h) for about 24 h though the renal function was not deranged. Out of six children with AKI, three (50%) in Stage III and three had AKI Stage II as per the AKIN criteria. Children with AKI (Group A) differed significantly from those without AKI (Group B) in having blood pressure <3rd centile (P = 0.0023), tachycardia P = 0.008), hyponatremia and hypokalemia (P <0.001 and P = 0.029, respectively) and poor outcome 6% mortality in Group B compared to 66.67% in Group A) with P = 0.001. AKI is not a common complication of DVI but if develops it may lead to significant morbidity and mortality among pediatric age group.