Novel cause of Acute Kidney Injury and its Predictors of Mortality

Abstract

Objective: Hypovolemia resulting from loss of massive amount of fluids via gastro intestinal tract and causing acute kidney injury (AKI) is seen less in developed countries, while in developing countries we still see large number of such cases. Present study is largest cohort of cases developing hypovolemia from gastro intestinal fluid loss causing AKI and study highlights mortality predictors related to this scenario.

Methodology: It is a retrospective cohort where case records of all the patients between January 1990 to December 2024, coming to Sindh Institute of Urology and Transplantation (SIUT), Karachi; who were labelled to have AKI according to KDIGO criteria, were reviewed. Patients developing AKI after acute diarrheal illness, with or without vomiting, were included and the data was analyzed and results are presented here.

Results: During the specified time of 35 years, total 1,456 cases of AKI after acute diarrheal illness were seen at this institution, these were 15.2% of total AKI. Mean age was 39.36 ±17.10(range from 18-100 years), male to female ratio was 2.21:1. Non-oliguric AKI was seen in 422 (29%), while 889 (61%) were oliguric and 145 (10%) were anuric. Renal replacement therapy in form of hemodialysis was required in 959 (66%) patients, while 497 (34%) were managed conservatively. Complete renal recovery was seen in 1160 (79.67%), while 125 during (8.58%) died acute phase of illness. Mortality was higher in patients who were hypotensive requiring inotropes, required mechanical ventilation, presented in altered state of consciousness, or developed cardiac arrhythmias with severe electrolyte imbalance. Many of those who died had combination of mentioned insults.

Conclusion: While world is moving towards digital and revolutionizing renal diagnosis globally, we face a reality of too many patients suffering from AKI with a preventable cause. We are losing lives with causes where AKI should not occur in first place.