Acute Kidney Injury among hospitalised children in a young tertiary centre in south-south, Nigeria: An observational prospective study

Background: Context: Paediatric acute kidney injury (AKI) often goes unrecognised in resource-limited emergency room settings and is a major contributor to morbidity and mortality. It is necessary to define the epidemiology of AKI in referral hospital settings where none exists. Objective: To determine the pattern, risk factors and outcome of acute kidney injury among children admitted into the Children's Emergency Room of Rivers State University Teaching Hospital (RSUTH). Methods: This prospective observational study involved all paediatric cases with KDIGO-defined AKI between October 2020 and October 2023 followed up for 3 months. Patients’ data prospectively documented included age, sex, presenting symptoms, diagnosis, blood pressure, urine output, blood chemistry, treatment, and outcome. Data were analysed. Results: Forty-three cases of AKI were seen, giving an incidence of 15.0 per 1000, 38 (88.4% were community-acquired). The mean age was 5.8 ±5.2 years (range: 2 months to 16 years) and 27(62.8%) were males. AKI was present in 38(88.4%) at presentation and 20(46.5%) had KDIGO stage III. The top four causes were: sepsis 16(37.2%), Primary renal diseases 10(23.3%), malaria 8(18.6%), gastroenteritis 5(11.6%). Seven (16.3%) required dialysis and mortality occurred in 7(16.3%). The risk of mortality was increased in those with sepsis [RR:13.6 (1.46 – 127.1)], late presentation [1.28(1.07 – 1.5)] and requiring dialysis [3.86(1.09 – 13.59)] Conclusion: AKI is common in the children's emergency room of RSUTH. Early presentation, screening for AKI and prompt treatment of underlying causes are imperative to improve outcomes. Funding and support for paediatric dialysis programmes for severe AKI are needed.