title: Acute kidney injury in scrub typhus.
abstract: BACKGROUND
  We studied the urinary abnormalities and acute kidney injury (AKI) as per RIFLE criteria in scrub typhus.
  
  
  METHODS
  A prospective case record-based study of scrub typhus was carried out from January 2009 to December 2010 in a tertiary hospital in South India. Patients were followed up until renal recovery or for at least 3 months after discharge. Univariate, chi-squared tests and multivariate logistic regression analyses were performed to identify the predictors of AKI.
  
  
  RESULTS
  Scrub typhus was diagnosed in 259 patients. Urinary abnormalities were seen in 147 patients (56.7%) with 60 patients (23.2%) having AKI. All AKI patients had urinary abnormalities and 17 (28.3%) were oliguric. Applying RIFLE (risk, injury, failure, loss, end-stage kidney disease) criteria, R, I, F were present in 23 (38.33%), 13 (21.67%), and 24 patients (40%), respectively. Creatine phosphokinase (CPK) was raised in 33 patients (55%) and hemodialysis was required in 6 patients (10%). The case fatality rate in this study was 2 out of 259 (0.77%), both having AKI and others recovering clinically. Significant predictors of AKI were tachycardia [odds ratio (OR) 2.28], breathlessness (OR 2.281), intensive care requirement (OR 2.43), mechanical ventilation (OR 3.33), thrombocytopenia (OR 2.90) and CPK>80 U/L (OR 1.76) by univariate analysis and intensive care requirement (adjusted OR 2.89) and thrombocytopenia (AOR 2.28) by multivariable logistic regression.
  
  
  CONCLUSIONS
  Scrub typhus should be part of the differential diagnosis of acute febrile illness with AKI. AKI in scrub typhus is usually mild, non-oliguric, and renal recovery occurs in most patients. Rhabdomyolysis may be contributory to AKI. Thrombocytopenia and intensive care requirement are significant predictors of AKI in scrub typhus.
authors.affiliation: Department of Nephrology, Kasturba Medical College and Hospital, Manipal, Manipal University, Madhavnagar, Manipal, Udupi District, 576104, Karnataka, India. aravindraprabhu@gmail.com.
authors.forename: Ravindra Prabhu
authors.initials: RP
authors.lastname: Attur
authors.affiliation: Department of Preventive and Social Medicine, Kasturba Medical College and Hospital, Manipal, Manipal University, Udupi District, Karnataka, India.
authors.forename: Sujatha
authors.initials: S
authors.lastname: Kuppasamy
authors.affiliation: Department of Nephrology, Kasturba Medical College and Hospital, Manipal, Manipal University, Madhavnagar, Manipal, Udupi District, 576104, Karnataka, India.
authors.forename: Manohar
authors.initials: M
authors.lastname: Bairy
authors.affiliation: Department of Nephrology, Kasturba Medical College and Hospital, Manipal, Manipal University, Madhavnagar, Manipal, Udupi District, 576104, Karnataka, India.
authors.forename: Shankar Prasad
authors.initials: SP
authors.lastname: Nagaraju
authors.affiliation: Department of Nephrology, Kasturba Medical College and Hospital, Manipal, Manipal University, Madhavnagar, Manipal, Udupi District, 576104, Karnataka, India.
authors.forename: Nageswara Reddy
authors.initials: NR
authors.lastname: Pammidi
authors.affiliation: Department of Preventive and Social Medicine, Kasturba Medical College and Hospital, Manipal, Manipal University, Udupi District, Karnataka, India.
authors.forename: Veena
authors.initials: V
authors.lastname: Kamath
authors.affiliation: Department of Preventive and Social Medicine, Kasturba Medical College and Hospital, Manipal, Manipal University, Udupi District, Karnataka, India.
authors.forename: Asha
authors.initials: A
authors.lastname: Kamath
authors.affiliation: Department of Pathology, Kasturba Medical College and Hospital, Manipal, Manipal University, Udupi District, Karnataka, India.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Rao
authors.affiliation: Department of Microbiology, Kasturba Medical College and Hospital, Manipal University, Udupi District, Karnataka, India.
authors.forename: Indira
authors.initials: I
authors.lastname: Bairy
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology* / Q000503:physiopathology / Q000628:therapy / Q000652:urine; D000328:Adult; D015415:Biomarkers / Q000652:urine; D016009:Chi-Square Distribution; D003402:Creatine Kinase / Q000652:urine; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007668:Kidney / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D009846:Oliguria / Q000453:epidemiology; D012285:Orientia tsutsugamushi / Q000302:isolation & purification*; D011446:Prospective Studies; D020127:Recovery of Function; D006435:Renal Dialysis; D012307:Risk Factors; D012612:Scrub Typhus / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003402:Creatine Kinase