title: Clinical profile of acute kidney injury in a pediatric intensive care unit from Southern India: A prospective observational study.
abstract: BACKGROUND
  Although the term acute renal failure was replaced by acute kidney injury (AKI) recently, there is a paucity of data on the incidence and profile of AKI in critically ill children from the developing world.
  
  
  OBJECTIVE
  The objective of this study is to determine the incidence, etiology, short term outcome and predictors of fatality in critically ill children admitted to the pediatric intensive care unit (PICU) with AKI, aged 1 month to 13 years.
  
  
  METHODS
  In this prospective observational study, from June 2010 to March 2011, 215 children admitted to the PICU were screened for AKI, defined according to the AKI Network criteria. The patients with AKI were followed-up until discharge/death. Their clinical and biochemical data were recorded.
  
  
  RESULTS
  The incidence of AKI among 215 patients screened was 54 (25.1%). The common etiologies were infections, [34 (62.9%)], acute glomerulonephritis (7.6%), snake envenomation (5.7%), hemolytic uremic syndrome (3.8%) and congestive cardiac failures (3.8%). Among infections, pneumonia and septicemia constituted 26.5% each, meningoencephalitis accounted for 23.5%, and dengue, scrub typhus, tuberculosis and malaria constituted 9.3% of children with AKI. 27.8% of patients required dialysis. Overall mortality was 46.3%. On logistic regression analysis, requirement of mechanical ventilation was an independent predictor of fatality in AKI.
  
  
  CONCLUSIONS
  Besides the high incidence of AKI in critically ill-children admitted to the PICU (25.1%), the condition was associated with adverse outcomes, including high mortality (46.3%) and need for dialysis (27.8%). Infections dominated the etiological profile. Requirement of mechanical ventilation predicted an adverse outcome in our patient population.
authors.affiliation: Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
authors.forename: Sriram
authors.initials: S
authors.lastname: Krishnamurthy
authors.forename: Parameswaran
authors.initials: P
authors.lastname: Narayanan
authors.forename: Sivaprakasam
authors.initials: S
authors.lastname: Prabha
authors.forename: Nivedita
authors.initials: N
authors.lastname: Mondal
authors.forename: Subramanian
authors.initials: S
authors.lastname: Mahadevan
authors.forename: Niranjan
authors.initials: N
authors.lastname: Biswal
authors.forename: Sadagopan
authors.initials: S
authors.lastname: Srinivasan
keywords: Acute kidney injury; critically ill-children; pediatric intensive care unit