Characteristics of acute kidney injury in patients infected with the 2009 influenza A (H1N1) virus.
OBJECTIVE
There have been few studies investigating acute kidney injury (AKI) in patients infected with the 2009 pandemic influenza A (H1N1) virus. Therefore, the objective of this study was to identify the factors associated with AKI in H1N1-infected patients.


METHODS
This was a study of 47 consecutive critically ill adult patients with reverse transcriptase-PCR-confirmed H1N1 infection in Brazil. Outcome measures were AKI (as defined by the Risk, Injury, Failure, Loss, and End-stage renal failure [RIFLE] criteria) and in-hospital death.


RESULTS
AKI was identified in 25 (53%) of the 47 H1N1-infected patients. AKI was associated with vasopressor use, mechanical ventilation, high Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, and severe acidosis as well as with higher levels of C-reactive protein and lactic dehydrogenase upon intensive care unit (ICU) admission. A nephrology consultation was requested for 16 patients (64%), and 8 (50%) required dialysis. At ICU admission, 7 (15%) of the 25 AKI patients had not yet progressed to AKI. However, by 72 hours after ICU admission, no difference in RIFLE score was found between AKI survivors and nonsurvivors. Of the 47 patients, 9 (19%) died, all with AKI. Mortality was associated with mechanical ventilation, vasopressor use, dialysis, high APACHE II score, high bilirubin levels, and a low RIFLE score at ICU admission.


CONCLUSIONS
Among critically ill H1N1-infected patients, the incidence of AKI is high. In such patients, AKI is mainly attributable to shock.
Abdulkader
Regina C R M
RC
Nephrology Department, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil. kader@usp.br
Ho
Yeh Li
YL
de Sousa Santos
Sigrid
S
Caires
Renato
R
Arantes
Marcia F
MF
Andrade
Lúcia
L
D018806:APACHE; D058186:Acute Kidney Injury / Q000175:diagnosis / Q000401:mortality / Q000628:therapy / Q000821:virology*; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D016009:Chi-Square Distribution; D003422:Critical Care; D016638:Critical Illness; D018450:Disease Progression; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D053118:Influenza A Virus, H1N1 Subtype / Q000235:genetics / Q000472:pathogenicity*; D007251:Influenza, Human / Q000175:diagnosis / Q000401:mortality / Q000628:therapy / Q000821:virology*; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000821:virology; D008297:Male; D008875:Middle Aged; D058873:Pandemics; D012367:RNA, Viral / Q000302:isolation & purification; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000401:mortality / Q000821:virology; D020133:Reverse Transcriptase Polymerase Chain Reaction; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D012367:RNA, Viral