A study of incidence, clinical and biochemical profile of acute kidney injury and comparison of p-rifle, akin and kdigo classification of acute kidney injury in paediatric intensive care unit of a tertiary care hospital

Background: Acute kidney injury (AKI) is a condition characterised by decrease in kidney function, impacting kidney’s ability to regulate fluid, electrolytes and acid-base homeostasis. AKI is commonly seen in children admitted in paediatric intensive care unit. The contributing factors of AKI have shifted from renal cause to multifactorial causes. Methods: This observational study was conducted in PICU of SSG Hospital over a period of 6 months after ethics approval. 205 patients aged 1 month to 11 years were enrolled. AKI was diagnosed and staged according to P-RIFLE, AKIN and KDIGO classification. Demographic data, etiological factors, duration of stay, outcome, electrolyte imbalances were recorded. The etiological risk factors for AKI like sepsis, dehydration, shock, mechanical ventilation, nephrotoxic drug exposure, pneumonia, tetanus, viral encephalitis, road traffic accidents, head injury, snake bite and diabetic ketoacidosis were analysed. Results: AKI was observed in 109 patients (53.17%), with highest incidence in infants (61.39%). Significant risk factors for AKI included mechanical ventilation (OR=3.1), sepsis (OR=3.9), shock (OR=7.6), and dehydration (OR=7.9). Mortality was higher in AKI patients (41.28%) compared to non-AKI patients (14.58%). P-RIFLE and KDIGO were more reliable than AKIN in diagnosing and staging AKI. Hypernatremia (20.18%) and Hyperkalemia (22.9%) were seen in patients with AKI. Ten patients needed peritoneal dialysis and rest responded to IV fluids. Conclusion: AKI is common complication in PICU, affecting mortality and ICU stay. Early detection and electrolyte monitoring are crucial for improving patient outcomes.