A prospective study of clinical profile of patients with acute kidney injury following acute gastroenteritis

 

Vikas Ramchandra Ratnaparkhe ^1*, Durgesh Kashinath Parhe²

 

Abstract              Background: Acute kidney injury (AKI), previously known as acute renal failure (ARF), characterized by sudden impairment of kidney function resulting in retention of nitrogenous and other waste products normally cleared by kidneys. AKI is not a single disease but, rather a heterogenous group of condition that share a common diagnostic features, especially increase in the blood urea nitrogen concentration and/or increase in plasma or serum creatinine concentration, often associated with reduction in urine volume. Materials and Methods: This study was carried out at tertiary care Teaching and General Hospital, during the period of October 2016 -June 2018. Consecutive cases presenting with AKI due to GE were enrolled in the study. All patients of either sex diagnosed as having Acute Kidney Injury due to gastroenteritis and presence of clinical manifestations of gastroenteritis were included in the study. Patients were categorized into Pre-Renal group and ATN group. Detailed history and clinical profile were recorded in these patients. Duration of GE and time period elapsed between GE and development of Acute Kidney Injury was recorded. Laboratory parameters such as CBC, renal function tests, serum electrolytes, urine examination and stool examination were done at the time of admission. Clinical and laboratory parameters were analysed to assess the role of each of these factors as possible outcome (Recovery or Death). Results: The commonest type of renal failure in our study was acute tubular necrosis 54%, followed by prerenalazotaemia46%. Out of 100 patients 82% survived and 18% expired. 64 patients had diarrhoea of less than 5 days with 43.75% in Prerenal and 56.25% in ATN Group and in 36 patients it was > 5 days with 50% in Prerenal and 50% in ATN group. The range of urine output was from 0 to 1300ml with an average of 415.7± 314.80. 30% had moderate dehydration. The mean interval between onset of GE and development of AKI was 3.14± 2.25 days. The mean peak creatinine was 5.478± 3.58 with 4.503± 3.54 in prerenal and 6.309± 3.43 in ATN group. At admission, the urea levels ranged between 30 to 401 mg/dl with mean of 150.51± 95.68. The mean peak urea level was 166.24± 96.14. Conclusion: Sustained hypovolemia is usually a cause of development of ATN in gastroenteritis. All patients who died belonged to ATN group. ATN is associated with poor outcome. But, AKI due to gastroenteritis definitely has lower mortality compared to AKI due to other causes. Some studies implicated age per se as one of the predictors for outcome in AKI. However, it is not possible to conclude whether age, sex and interval between the onset of gastroenteritis and development of AKI are independent predictors in the outcome of AKI from our study as it included only a small number of patients belonging to a restricted age group.

Key words: Acute kidney injury, Sustained hypovolemia, ATN, acute tubular necrosis.