Warning: file_get_contents(https://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=29805409
&cmd=llinks): Failed to open stream: HTTP request failed! HTTP/1.1 429 Too Many Requests
in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 215
Frequency of Acute Kidney Injury in tetanus patients of Paedriatic Intensive Care
Unit: A Public Hospital Experience
#MMPMID29805409
Naseem F
; Hussain A
; Arif F
Pak J Med Sci
2018[Mar]; 34
(2
): 363-367
PMID29805409
show ga
BACKGROUND AND OBJECTIVE: Tetanus is a potentially fatal but preventable disease.
Mortality is related to severity of the disease, cardiovascular, pulmonary and
renal complications. Acute kidney injury (AKI) is a frequent and lethal
complication of tetanus. The objective was to determine the frequency of AKI in
tetanus patients managed in a public hospital. METHODS: Children aged 1-12 years
admitted in Paediatric Intensive Care Unit (PICU) with the clinical diagnosis of
tetanus over three and half years were recruited for the retrospective study.
pRIFLE (Pediatric Risk, Injury, Failure, Loss, End) criteria was applied to all
cases of tetanus to categorize them as having AKI or not, on the basis of
estimated creatinine clearance (ECCL). Comparison was done between AKI and
non-AKI cases, as well as between AKI survivors and AKI non-survivors. The study
was conducted at PICU of Dr. Ruth K.M. PFau Civil Hospital Karachi for tetanus
cases admitted during July 2013 to December 2016. RESULTS: During the study
period, 44 patients of tetanus were enrolled. Nearly 32 % of tetanus patients
developed acute renal dysfunction according to PRIFLE criteria. There were
overall 15 (34.09%) expiries among tetanus patients among which nine (60%) had
AKI. Oliguria was observed in five (35.71%) cases. All the AKI non-survivors had
ECCL below 50% and all had autonomic instability. AKI developed towards the end
of first week in three cases, mid of second week in four cases and third week in
seven cases. Renal replacement therapy (RRT) i.e. peritoneal dialysis (PD) was
done in four AKI cases but it did not improve the outcome. CRP was more than 50
in 24 (54.54%) cases. Ventilatory support was given to 85.71% with AKI as
compared to 66.66% of non AKI patients. CONCLUSION: Development of AKI in tetanus
is multifactorial. Major contributors are severity of the tetanus itself,
presence of autonomic instability, ventilator dependency, and sepsis. Presence of
AKI worsens the outcome of tetanus in terms of survival, length of stay, hospital
cost and ventilator days.
free
free
free
