Acute Kidney Injury Due to Rickettsial Infection - Data from a Tertiary Care Center in Southern India

Background Scrub typhus, caused by Orientia tsutsugamushi , is an underdiagnosed tropical infection endemic to India, often presenting with non-specific symptoms. AKI is a serious yet potentially reversible complication that significantly impacts outcomes. This study aimed to determine the prevalence, clinical characteristics, and predictors of AKI in patients primarily diagnosed with scrub typhus at a tertiary care center in Southern India. Materials and Methods This retrospective observational study analyzed 176 adult patients with rickettsia at a tertiary care center in Karnataka from January 2021 to December 2024. Patients with co-infections were excluded. AKI was defined and staged per KDIGO criteria. Demographic, clinical, laboratory, and outcome data were assessed to identify predictors of AKI. Results The prevalence of AKI was 44 (25%), with a mean age of 37.5 ± 16.3 years. KDIGO categorizes AKI into Stage 1 (15.3%), Stage 2 (4.5%), and Stage 3 (5.1%); 4% required dialysis. Winter seasonality (44% cases in Dec-Feb) was noted. Independent predictors of AKI included older age (OR 3.60), male sex (OR 4.14), diabetes mellitus (OR 3.13), septic shock (OR 5.42), and Multi-organ dysfunction syndrome (MODS) (OR 52.8). Hypoalbuminemia was also associated with AKI. Overall mortality was 2.8%. Conclusion AKI occurs in 1/4 of scrub typhus patients and is associated with substantial morbidity, especially among elderly males with comorbidities and systemic complications. Despite its severity, AKI in scrub typhus is often reversible with early recognition and aggressive supportive care. These findings highlight the need for heightened clinical suspicion and timely intervention in endemic settings to reduce AKI-related complications.