ABSTRACT
Background: Worldwide incidence and causes of acute kidney injury (AKI) are variable and even more in developed and developing countries. At least 80% of AKI in tropics is community acquired. Acute gastroenteritis (AGE) is a common problem in developing countries. Present study concentrates on AGE as cause of AKI during monsoon period. It presents in epidemic proportion during monsoon and is preventable with timely intervention.Methods: The study was carried out prospectively in tertiary care hospital in Mumbai during monsoon season of 2012 and 2013. AKI was staged as per AKIN criteria. Patients were treated for primary disease and AKI, initially conservatively and dialysis if indicated. Patients were followed during the hospital stay.Results: Two hundred and thirty patients had AKI due to infectious disease during monsoon. Incidence of AKI due to diarrhea was 23%, and affecting males predominantly in 4th decade. Diarrhea and vomiting were the most common presenting complaints. 32% patients required dialysis. Mortality rate was 3.8%.Conclusions: AKI secondary to AGE is common in tropics. Treatment of primary disease and hemodynamic optimization at the earliest helps to prevent AKI. Presents with less severe AKI and has better outcome. Multiorgan involvement and need for supportive lifesaving therapies were risk factors for AKI.
ABSTRACT
Background: Acute kidney injury (AKI) after cardiac surgery (CS) is not uncommon and has serious effects on mortality and morbidity. A majority of patients suffer mild forms of AKI. There is a paucity of Indian data regarding this important complication after CS. Aims and Objectives: The primary objective was to study the incidence of AKI associated with CS in an Indian study population. Secondary objectives were to describe the risk factors associated with AKI-CS in our population and to generate outcome data in patients who suffer this complication. Methods: Serial patients (n = 400) presenting for adult CS (emergency/elective) at a tertiary referral care hospital in South India from August 2016 to November 2017 were included as the study individuals. The incidence of AKI-CS AKI network (AKIN criteria), risk factors associated with this condition and the outcomes following AKI-CS are described. Results: Out of 400, 37 (9.25%) patients developed AKI after CS. AKI associated with CS was associated with a mortality of 13.5% (no AKI group mortality 2.8%, P = 0.001 [P < 0.05]). When AKI was severe enough to need renal replacement therapy, the mortality increased to 75%. Patients with AKI had a mean hospital stay 16.92 ± 12.75 days which was comparatively longer than patients without AKI (14 ± 7.98 days). Recent acute coronary syndrome, postoperative atrial fibrillation, and systemic hypertension significantly predicted the onset of AKI-CS in our population. Conclusions: The overall incidence of AKI-CS was 9.25%. The incidence of AKI-CS requiring dialysis (Stage 3 AKIN) AKI-CS was lower (2%). However, mortality risks were disproportionately high in patients with AKIN Stage 3 AKI-CS (75%). There is a need for quality improvement in the care of patients with AKI-CS in its most severe forms since mortality risks posed by the development of Stage 3 AKIN AKI is higher than reported in other index populations from high resource settings.