Clinical Profile and Outcome of Acute Kidney Injury in Children Less than 5 Years: A Two-Year Retrospective Study in a Resource Limited Setting

Abstract

Background: Younger children are more vulnerable to acute kidney injury. We aimed to determine the prevalence, aetiological factors, clinical features, and outcome of acute kidney injury (AKI) in children aged 29 days to 5 years. Method: We retrospectively reviewed hospital records of children less than 5 years admitted in the paediatrics ward and the Intensive care unit from the 1st of January 2021 to the 1st of March 2023. We defined AKI using the Kidney Disease: Improving Global Outcome (KDIGO) criteria. Our outcomes of interest were the need for dialysis, death, and renal recovery at discharge. Data were analysed using STATA version 17 SE. A p-value of less than 0.05 was considered statistically significant. Results: Out of 3393 patients, 54 (1.6%) had AKI either on admission or during the course of treatment. The median age of our participants was 22 months. Sepsis (n = 47; 87%), severe malaria (n = 17; 31.5%), and the use of nephrotoxins (n = 15; 27.8%) were the most common aetiologies of AKI. All but one of our participants was in KDIGO stage 3 AKI. Dialysis was indicated for 75.9% (n = 41) of the patients. But done only in 32% (n = 13). The reasons for no dialysis were inappropriate logistics (n = 16, 57.1%), death before initiation of dialysis (n = 8, 28.6%), and family refusal (n = 4, 14.3%). The mortality rate was 66.7% (n = 36). Conclusion: About 15 in a thousand children aged 29 days to 5 years developed AKI during hospital stay. Sepsis, severe malaria, and the use of nephrotoxins were the most common aetiologies of AKI. Dialysis was often needed and not done, and the mortality rate was high.