FROM FEVER TO RENAL FAILURE: OUTCOMES OF TROPICAL FEVER ASSOCIATED ACUTE KIDNEY INJURY IN TERTIARY CARE CENTRE

Introduction:

Tropical fevers, prevalent in tropical and subtropical regions, often lead to acute kidney injury (AKI). The incidence and outcomes of AKI in these infections vary by location and season. This study investigates the clinical and etiological features of AKI linked to tropical fevers, assesses short-term outcomes such as hospital stay duration, interventions, and mortality rates, and identifies factors influencing mortality and dialysis needs to enhance management.

Methods:

Prospective observational study was conducted at a tertiary hospital from December 2023 to August 2024. It included patients aged 12 and older with acute febrile illness (fever >48 hours but <10 days) and AKI per KDIGO guidelines. Excluded were those with recent hospitalization, recent travel, known CKD, or pregnancy/postpartum status. Data included demographics, clinical features, lab parameters (CBC, electrolytes, creatinine, liver function tests, ultrasound), and treatments (vasopressors, ventilator support, RRT). SOFA and Modified Faine scores were calculated. ROC curves assessed for these scores. Patients had a three-month follow-up. Data were analyzed using SPSS.

Results:

The study included 116 patients (mean age 44.2 years; 81% male) with an average hospital stay of 14.3 days. Comorbidities included diabetes (22%), hypertension (12.9%), addiction (37.1%), and CAD (3.4%). Diabetes and residence were linked to AKI severity, as were longer fever duration and lower MAP.

Symptoms at admission included loose stools (47%), vomiting (61%), jaundice (32%), and myalgia (50%).Tachycardia was noted in 40%, with MAP <75 mmHg in 78%. Ventilation support was required in 29.2%. Initial lab findings showed WBC 9,200/µL, neutrophils 73%, platelets 2,000/µL, urea 78mg/dL and Cr 2.1mg/dL. Follow-up showed increased WBC (13,414/µL) and decreased platelets (69,900/µL) with Peak urea 136.9 mg/dL and creatinine 4 mg/dL. AKI stages evolved from Stage 1 (49.1%), Stage 2 (30.2%), and Stage 3 (20.7%) at admission to Stage 1 (17.2%), Stage 2 (40.5%), and Stage 3 (42.2%).

Oliguria was present in 12% at admission, increasing to 31% on follow-up. Urine albumin was seen in 18%. Bilirubin averaged 3.1 mg/dL at admission and peaked at 4.8 mg/dL, and serum albumin was 3.1 g/dL. Ultrasound findings showed normal studies in 25%, increased renal echoes in 44.8%, splenomegaly in 13%, hepatosplenomegaly in 14% and gallbladder edema in 10.3%.

Infections were identified as leptospirosis (23.3%), scrub typhus (7.8%), dengue (13.8%), and typhoid fever (12.9%). Leptospirosis was linked to severe AKI (18% Stage 3) and had the highest RRT requirement (29.3%: acute peritoneal dialysis 22.4%, hemodialysis 13.8%). Severe AKI cases had elevated TC, LDH, and CPK levels, and lower albumin. Full recovery was seen in 62.9%, partial recovery in 27%, and mortality in 10%. ROC curves showed high predictive values for SOFA score (AUC 1.0), Modified Faine score (0.97), peak bilirubin (0.82), urine output (0.88), and LDH (0.98).

Conclusions:

The study highlights the impact of diabetes, residence, fever duration, and MAP on AKI severity. Leptospirosis was most frequently associated with severe AKI and increased RRT needs. Severe AKI correlated with higher mortality and partial recovery rates. SOFA and Modified Faine scores were effective in assessing AKI severity.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.