Incidence and recognition of acute kidney injury in a semirural pediatric ward in Cameroon: a single-center prospective study

BACKGROUND: Early detection of acute kidney injury (AKI) remains a significant hurdle. This study evaluated the incidence and recognition of AKI in a semirural pediatric ward in Cameroon. METHODS: We conducted a prospective observational study over a four-months period at the Kribi Regional Annex Hospital. Children aged 2 to 15 years who were admitted within less than 24 h before recruitment were included. All patients were followed up for at least 48 h. AKI was defined and staged according to the modified KDIGO (Kidney Disease: Improving Global Outcomes) 2012 criteria. The knowledge and attitudes of healthcare providers were assessed via a self-administered questionnaire. RESULTS: Out of 300 admissions, 150 children were included (median age 7 years [IQR 3-10]). The overall incidence of AKI was 14.7% (n = 22). Among children at risk (69%, n = 104), the incidence reached 21.1%. AKI was exclusively community-acquired. It was prerenal in 91% (n = 20) and stage 1 in 59% (n = 13) of patients. The recognition rate was only 9% (2/22). Both recognized cases were stage 3 with overt clinical signs (malnutrition and edema). Healthcare provider's knowledge was rated as poor, insufficient, or fair among all healthcare providers. Other barriers to AKI recognition included the lack of clinical protocols (36.4%), the absence of specific clinical signs (36.4%), and overreliance on serum creatinine alone (urine output monitoring was not utilized). CONCLUSION: AKI is frequent in a semirural setting in Cameroon but seems to remain largely invisible to clinicians. Implementation of the ISN 5R strategy, clinician training on KDIGO criteria and improved laboratory access may increase AKI recognition.