title: Defining acute kidney injury in dengue viral infection by conventional and novel classification systems (AKIN and RIFLE): a comparative analysis.
abstract: BACKGROUND
  Several criteria have been used to stratify acute kidney injury (AKI) in dengue infection and have resulted in variations in its incidence as well as clinic-laboratory characteristics. The current study was aimed to compare three commonly used criteria of AKI among patients with dengue.
  
  
  METHODS
  667 patients with dengue were defined and staged according to the conventional definition (CD), the Acute Kidney Injury Network (AKIN) and the Risk, Injury, Failure, Loss of function, End stage renal disease (RIFLE) criteria. Appropriate statistical methods were used to compare these three criteria.
  
  
  RESULTS
  The incidence of AKI during dengue infection was 14.2% by AKIN criteria, 12.6% by RIFLE criteria and 4.2% by CD. AKIN and RIFLE criteria were comparable while AKIN-I identified 11 more patients with AKI than RIFLE-R (76.8% vs. 73.8%, p=0.023). CD was found to be less sensitive than AKIN and RIFLE due to stratification of only severe AKI cases with serum creatinine ≥176.8 µmol/L. Overall mortality was 1.2% and severe stages of AKI were associated with increased mortality (p<0.001). AKIN criteria identified seven risk factors, RIFLE identified six and CD identified three risk factors. Old age, severe dengue and the use of nephrotoxic drugs were found to be independent predictors identified by all criteria while hypertension was only identified by AKIN.
  
  
  CONCLUSIONS
  The incidence of AKI in dengue infection, the risk factors for its development and clinico-laboratory characteristics vary significantly according to the diagnostic criteria used. In our analysis, AKIN and RIFLE were comparable to each other and superior to CD with regard to early diagnosis and sensitivity.
authors.affiliation: Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia.
authors.forename: Tauqeer Hussain
authors.initials: TH
authors.lastname: Mallhi
authors.affiliation: Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia.
authors.forename: Amer Hayat
authors.initials: AH
authors.lastname: Khan
authors.affiliation: Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia.
authors.forename: Azmi
authors.initials: A
authors.lastname: Sarriff
authors.affiliation: Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, University Sains Malaysia, Kota Baru, Kelantan, Malaysia.
authors.forename: Azreen Syazril
authors.initials: AS
authors.lastname: Adnan
authors.affiliation: Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia.
authors.forename: Yusra Habib
authors.initials: YH
authors.lastname: Khan
authors.affiliation: Department of Obstetrics and Gynecology, School of Medical Sciences, Health Campus, University Sains Malaysia, Kota Baru, Kelantan, Malaysia.
authors.forename: Fauziah
authors.initials: F
authors.lastname: Jummaat
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D000367:Age Factors; D000998:Antiviral Agents / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury / Q000150:complications / Q000453:epidemiology*; D003715:Dengue / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014765:Viral Vaccines / Q000009:adverse effects
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D014765:Viral Vaccines
keywords: INFECTIOUS DISEASES