Clinical Profile of Patients with Acute Kidney Injury following Acute Gastroenteritis

BACKGROUND Acute Kidney Injury is a syndrome characterized by rapid decline in glomerular filtration rate and retention of nitrogenous waste products such as blood urea nitrogen and creatinine. It is one of the common and dramatic syndromes encountered in clinical practice. Gastroenteritis is inflammation of stomach and small intestine producing nausea, vomiting and diarrhea. METHODS This study was carried out at Basaveshwara Teaching and General Hospital, Gulbarga during the period of October 2016 - June 2018. Consecutive cases presenting with AKI due to GE were enrolled in the study. All patients of either sex diagnosed as having Acute Kidney Injury due to gastroenteritis and presence of clinical manifestations of gastroenteritis were included in the study. Patients were categorized into Pre-Renal group and ATN group. Detailed history and clinical profile were recorded in these patients. Duration of GE and time period elapsed between GE and development of Acute Kidney Injury was recorded. Laboratory parameters such as CBC, renal function tests, serum electrolytes, urine examination and stool examination were done at the time of admission. Clinical and laboratory parameters were analyzed to assess the role of each of these factors as possible outcome (Recovery or Death). RESULTS The commonest type of renal failure in our study was acute tubular necrosis 54%, followed by prerenal azotaemia 46%. Out of 100 patients 82% survived and 18% expired. 64 patients had diarrhoea of less than 5 days with 43.75% in Prerenal and 56.25% in ATN Group and in 36 patients it was > 5 days with 50% in Prerenal and 50% in ATN group. The range of urine output was from 0 to 1300 ml with an average of 415.7 +/- 314.80. 30% had moderate dehydration. The mean interval between onset of GE and development of AKI was 3.14 +/- 2.25 days. The mean peak creatinine was 5.478 +/- 3.58 with 4.503 +/- 3.54 in prerenal and 6.309 +/- 3.43 in ATN group. At admission, the urea levels ranged between 30 to 401 mg/dl with mean of 150.51 +/- 95.68. The mean peak urea level was 166.24 +/- 96.14. CONCLUSIONS Gastroenteritis is one of the leading causes of AKI. Male preponderance was noted. The highest incidence of disease was seen during April to August coinciding with the period of peak incidence of gastroenteritis in tropics. Morbidity was more in patients with higher creatinine levels than in those with lower creatinine levels. Hypokalemia is an important electrolyte disturbance in AKI due to gastroenteritis. Urinary output and septicemia can be considered as the important prognostic factors for the disease with septicemia being the main cause of death.