Acute kidney injury in Pediatric Intensive Care Unit: Incidence, risk factors, and outcome.
OBJECTIVE
To determine incidence, risk factors, and outcome of acute kidney injury (AKI) in Pediatric Intensive Care Unit (PICU).


METHODS
This is a prospective, observational study conducted in PICU of Department of Paediatrics, S.P. Medical College, Bikaner, from October 2013 to May 2014. In this study, 536 patients of aged 29 days to 16 years were screened for AKI according to the Pediatric Risk, Injury, Failure, Loss, End-stage Renal Disease (pRIFLE) criteria. Their clinical and biochemical data were recorded and followed up to their discharge/death.


RESULTS
During the study period, 230 (42.9%) out of 536 patients developed AKI. Younger age (<5 years) and females (P ≤ 0.013) were more prone to develop AKI. Most common etiologies were septicemia, multiple organ dysfunction syndrome (MODS), gastroenteritis, and severe malaria (P ≤ 0.05). The maximal stage of AKI was stage "R" (49.1%), followed by "I" (29.5%) and "F" (21.3%). Major PICU-related risk factors were use of vasoactive drug (VD) and nephrotoxic drug (ND) and need of mechanical ventilation (MV) (P ≤ 0.05). Length of stay was significantly longer than non-AKI patients (P ≤ 0.05). Mortality in AKI (47.5%) was higher (P ≤ 0.05%) in comparison to non-AKI (25.56%).


CONCLUSIONS
AKI is common in critically sick children, especially in younger age and in females with septicemia and MODS. Use of VD and ND and need of MV are common risk factors. AKI is associated with longer hospital stay and higher mortality. pRIFLE is better diagnostic criteria in early detection of AKI and reduction of their morbidity and mortality.
Department of Pediatrics, S.P. Medical College, Bikaner, Rajasthan, India.
Sheetal
S
Gupta
Department of Pediatrics, S.P. Medical College, Bikaner, Rajasthan, India.
Ghanshyam Singh
GS
Sengar
Department of Pediatrics, S.P. Medical College, Bikaner, Rajasthan, India.
Praveen K
PK
Meti
Department of Pediatrics, S.P. Medical College, Bikaner, Rajasthan, India.
Anil
A
Lahoti
Department of Pediatrics, S.P. Medical College, Bikaner, Rajasthan, India.
Mukesh
M
Beniwal
Department of Pediatrics, S.P. Medical College, Bikaner, Rajasthan, India.
Murlidhar
M
Kumawat
Acute kidney injury; Pediatric Intensive Care Unit; critically ill children; pRIFLE
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