Introduction:
Acute kidney injury(AKI) presents variably depending on its context. While AKI in developed countries is often hospital-acquired(HA-AKI), community-acquired AKI(CA-AKI) predominates in tropical regions like India. AKI in tropics often affects younger individuals, typically due to a single cause such as infection, environmental toxin exposure, envenomation, or childbirth complications. In this study we aim to evaluate the clinical characteristics, etiology and short term renal outcomes, to assess the need for RRT, to evaluate renal recovery and progression in tropical AKI syndromes in a tertiary care hospital in Telangana, India.
Methods:
This retrospective observational study was conducted in the Department of Nephrology, a tertiary care hospital in Telangana, India, from 2021 to 2024. The study included 416 patients aged ≥1 year who were admitted with AKI based on KDIGO-2012 criteria. Patients with AKI after 48 hours of hospitalization, CKD patients on dialysis, septic AKI, and obstructive AKI were excluded. Data on demographics, comorbidities, and clinical information were collected, with serum creatinine levels recorded at admission, discharge and 3 months post-discharge. Statistical analysis was performed using standard parametric and non-parametric tests.
Results:
The study included 416 patients, 45% male and 55% female, with a mean age of 34.03 ± 15.05 years. Of these, 6.1% were under 18 years old. The majority(93.9%) were adults, with 53.3% residing in rural areas, mostly from upper-lower socio-economic backgrounds(70.8%). 73% had AKI stage 3, followed by stage 2(17%). Etiology of tropical AKI included Fever-AKI (40.7%), Obstetric-AKI(36.3%), and Envenomation & Poisoning(20.9%). Infections accounted for 44.9% of cases, with diarrheal disease(40.9%), HIV(15.9%), leptospirosis(13.6%), dengue(9.1%), and malaria(6.8%) being common. Thrombocytopenia(38.8%), jaundice(25.5%), and hemolysis(14.3%) were notable findings. Among obstetric AKI cases, 76.4% were fully booked cases. Renal biopsy revealed acute tubular injury(56.4%), acute tubulointerstitial nephritis(17.9%), and patchy cortical necrosis(10.3%). RRT was required in 61.2% of patients, with intermittent hemodialysis(85%) being the most common modality. At discharge, 53.1% of patients achieved complete renal recovery, 39.8% had partial recovery, and 7.1% required long-term hemodialysis. Follow-up data revealed that 42.9% of patients did not return for follow-up, and 32.1% were lost after 1-3 visits. By 3 months, 15.5% of patients had progressed to CKD.
Conclusions:
Community-acquired AKI in tropics are predominantly caused by infections and obstetric complications, both largely preventable. In light of the ongoing 0 by 25 campaign, we should focus on preventable deaths due to AKI, of which tropical AKI constitutes ample number of cases. Prevention strategies should focus on improving socio-economic conditions, enhancing public health measures, providing better obstetric care, and raising awareness about safe pesticide use. Early referral to dialysis equipped centers can improve outcomes in established AKI cases.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.