Etiology, clinical profile and short-term outcome of acute kidney injury in children at a tertiary care pediatric nephrology center in Pakistan

Figures & data

Table 1. Etiology of acute kidney injury (AKI) in 116 children.

Etiologies of pediatric AKI
Pre-renal			Renal			Postrenal
n = 11 (9.5%)			n = 74 (63.8%)			n = 28 (24.1%)			Unknown etiology
Etiology	n	%	Etiology	n	%	Etiology	n	%	n = 3 (2.6%)
Sepsis	8	72.7%	PIGN	26	35.1%	Obstructive urolithiasis	24	85.7%
Gastroenteritis	1	9.1%	Crescentic GN	20	27%	Bilateral PUJO	2	7.1%
Liver-related disease	1	9.1%	HUS	8	10.8%	Posterior urethral valves	2	7.1%
Shock	1	9.1%	Envenomation	8	10.8%
			Malarial nephropathy	6	8.1%
			Drugs/Toxins	2	2.7%
			ATN	3	4.0%
			Mesangiocapillary GN	1	1.3%

ATN: acute tubular necrosis; GN: glomerulonephritis; HUS: hemolytic uremic syndrome; PIGN: post infectious GN; PUJO: pelvi–ureteric junctional obstruction.

Table 2. Clinical characteristics and supportive care required for acute kidney injury (AKI) cases.

Characteristics	Frequency
Presenting Features
Oliguria/anuria	97 (83.6%)
Fever	76 (65.5%)
Edema	60 (51.7%)
Vomiting	42 (36.2%)
Clinical features at presentation
Severe anemia (Hb <6 g/dl)	20 (17.2%)
Hypertension (BP >95th centile)	43 (37.1%)
Volume overload	19 (16.4%)
Supportive care
Ventilatory support	9 (7.8%)
Dialysis	62 (53.4%)

Figure 1. pRIFLE Category at Presentation of AKI cases.

Figure 2. The outcome of children with AKI at 3 months of follow-up.

Table 3. Outcome according to pRIFLE category at presentation.

	Outcome (n = 116)
pRIFLE category n = 116	Recovered n = 68	CKD n = 18	ESRD n = 22	Death n = 6	Lost to follow-up n = 2
Risk, n = 11	11 (100%)	–	–	–	–
Injury, n = 16	12 (75%)	4 (25%)	–	–	–
Failure, n = 89	45 (50.5%)	14 (15.7%)	22 (24.7%)	6 (6.7%)	2 (2.2%)

CKD: chronic kidney disease; ESRD: end-stage renal disease.

Table 4. Outcome according to etiological category of renal disease.

	Outcome n = 116
Etiology of AKI n = 116	Recovered n = 68	CKD n = 18	ESRD n = 22	Death n = 6	Lost to follow-up n = 2
PIGN, n = 26	22 (84.6%)	4 (15.4%)	–	–	–
Obstructive urolithiasis, n = 24	20 (83.3%)	2 (8.3%)	–	2 (8.3%)	–
Crescentic GN, n = 20	1 (5%)	4 (20%)	14 (70%)	1 (5%)	–
Sepsis, n = 8	1 (12.5%)	2 (25%)	2 (25%)	2 (25%)	1 (12.5%)
HUS, n = 8	3 (37.5%)	2 (25%)	2 (25%)	–	1 (12.5%)
Envenomation, n = 8	6 (75%)	–	2 (25%)	–	–
Malarial nephropathy, n = 6	2 (33.3%)	3 (50%)	1 (16.6%)	–	–
PUJO & PUV, n = 4	4 (100%)	–	–	–	–
ATN, n = 3	2 (66.6%)	–	1 (33.3%)	–	–
Drugs & toxins, n = 2	1 (50%)	1 (50%)	–	–	–
Acute gastroenteritis, n = 1	1 (100%)	–	–	–	–
Shock, n = 1	1 (100%)	–	–	–	–
Mesangiocapillary GN, n = 1	1 (100%)	–	–	–	–
Cholemic nephrosis, n = 1	1 (100%)	–	–	–	–
Unknown etiology, n = 3	2 (66.6%)	–	–	1 (33.3%)	–

ATN: acute tubular necrosis; GN: glomerulonephritis; HUS: hemolytic uremic syndrome; PIGN: post infectious GN; PUJO: pelvi–ureteric junctional obstruction; PUV: posterior uretheral valves.

Table 5. Independent variables in recovered versus unrecovered acute kidney injury (AKI) cases.

Variables	Recovered n = 69 (59.5%)	Unrecovered n = 47 (40.5%)	p value
Age less than 5 years	27 (39.7%)	12 (25.0%)	.09
Oliguria/anuria	54 (79.4%)	43 (89.6%)	.14
Edema	29 (42.6%)	31 (64.6)%)	.02
Hypertension (BP >95th centile)	17 (25.0%)	26 (54.2%)	.001
Severe anemia (Hb <6 g/dl)	7 (10.3%)	13 (27.1%)	.01
Volume overload	5 (7.4%)	14 (29.2%)	.002
pRIFLE category failure	45 (66.2%)	44 (91.7%)	.001
Required dialysis	21 (30.9%)	41 (85.4%)	<.001
Required >5 dialysis sessions	3 (4.4%)	32 (66.7%)	<.001
Mechanical ventilator support	1 (1.5%)	8 (16.7%)	.003