FP270A STUDY ON THE EPIDEMIOLOGY & OUTCOME OF TROPICAL ACUTE KIDNEY INJURY IN A TERTIARY CARE HOSPITAL IN EASTERN INDIA

Abstract

Introduction and Aims: To evaluate the incidence, clinical profile and outcome of patients of tropical acute kidney injury admitted in a tertiary care hospital in Eastern India. Methods: It is an observational, hospital based, single-centred study conducted from January 2016-August 2017. Patients between the age 18-90 years and of both gender admitted in the medicine ward. All patients with AKI admitted due to diseases or conditions attributable to tropical climate, socio economic conditions, practises were included in the study. AKI has been defined by RIFLE/AKIN criteria. All the patients enrolled were followed up till discharge/discharge on risk bond or death. The length of hospital stay of each patient, the number of renal replacement therapy as haemodialy-sis, final creatinine level on discharge will be recorded. Outcome will measured on the basis of the above mentioned parameters. The patients were followed up at three months after the date of discharge and the serum creatinine will be documented. Results: In the present study out of 132 newly detected patients with AKI due to some tropical conditions and diseases,38 patients had dengue fever,33 had Falciparum Malaria,2 patients had malaria due to both P. falciparum and P.vivax, 24 patients had leptospirosis, 20 patients had snakebite,12 had P.vivax malaria,3 patients had Scrub typhus. In our study out of 132 patients with AKI due to tropical cause 28 had dehy-dration(21.2%) among whom were 19 (50%) patients of Dengue,6 (18.2%)patients of Falciparum malaria.Oedema was present in 54 patients(40.9%). Icterus was present in 48(36.4%) patients among whom 27 patients had Falciparum malaria(81.8% were icteric),Jaundice is the most common association of MAKI, occurring in more than 75% of cases.Renal replacement therapy in the form of intermittent haemodialysis was needed by 103 patients (78.03%).29 patients (21.96%) did not require any form of renal replacement therapy. Supportive treatment was adequate for recovery in these patients. Mean hemodialysis needed for snakebite patient was highest 5.40 +-2.333,followed by dual malaria patients with mean of 3.00+-0.00,leptospira patients needing a mean of 2.75+-0.953 dialysis, vivax malaria patients needing a mean of 2.75+-1.54 dialysis, fal-ciparum malaria needing 2.39+-1.093 mean dialysis, scrub typhus patients needed 2.333+-0.5774 mean dialysis. The mean hospital stay for the patients of tropical AKI was 9.24+-4.79 days (p<0.0001) with snakebite patients having highest mean hospital stay of 14.9 +-5.99 days and malaria due to both P. vivax and P.falciparum having least mean hospital stay of 6 +-.000 days. In our present study out of the 132 patients of tropical AKI, at the end of hospital stay, we had discharge on cure of 110 patients (83%), discharge on request of 7 patients(5.3%) and death of 15 patients (11.4%) p<0.001. Mean creatinine on discharge was 1.0427-+0.3144.Mean creatinine on follow up after 3 months after discharge was 0.9357+-0.2433. 8 out of 115(6.95%) patients who had returned for follow up had raised creatinine (>1.2) and therefore can be declared to have developed chronic kidney disease. In the rest of the patients creatinine at three months of follow up was found to be touching baseline(early recovery). Conclusions: Mosquito born diseases like dengue and malaria, snakebite, zoonosis like leptospirosis forming the bulk of tropical AKI. Most of these are preventable. Antimosquito measures, at administrative and indivisual levels can reduce the transmission of dengue and malaria. A greater awareness and earlier contact with medical authorities can reduce the burden of tropical AKI.