Community Acquired Acute Kidney Injury Among Children at Usmanu Danfodiyo University Teaching Hospital, Sokoto

Jiya Fatima Bello; Ibitoye Paul Kehinde; Jiya Nma Muhammed; Jibrin Baba; Adamu Asma’u; Isezuo Khadijat Omeneke; Obasi Izuchukwu

doi:7170340

Background: Acute kidney injury (AKI) remains an important cause of morbidity and mortality particularly in developing countries. Community acquired forms are more prevalent in our setting, due perhaps to high occurrence of infectious diseases of relevance to the development of AKI. The Objectives of the study were: To determine the prevalence, pattern and outcome of AKI among children at Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto. This was a 2- year retrospective descriptive study from September 2015 to August 2017. Cases were children aged 2 months to 14 years admitted into Emergency Paediatric Unit (EPU) of Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, with diagnosis of AKI using kidney disease improving global outcome criteria. Relevant information from their case folders were extracted into a profoma sheet and data was analyzed using SPSS version 20. Results: Thirty six of the 3493 admissions had diagnosis of AKI, giving a prevalence of 10.3 AKI cases per 1000 children. Males were 22 (61.1%) and females were 14 (38.9%), with M:F ratio 1.5:1. Mean age at presentation was 2.47 ± 1.4 years. Majority 20 (55.6%) were of low socioeconomic class. The common presenting symptoms were reduced or non-passage of urine in 23 (63.9%) of the patients, body swelling 22 (61.1%), and fever 14 (38.9%). Acute glomerulonephritis 10 (27.7%), Obstructive uropathy 7 (19.4%) and Septicaemia 6 (16.6%) were the commonest aetiologic diagnosis. Majority 21 (58.3%) of them had AKI stage 3. Three (50.0%) of the six patients with indication for dialysis underwent peritoneal dialysis. Twenty six (72.2%) of the 36 patients were discharged, 6 (16.7%) died and 4 (11.1%) left against medical advice. Of the 26 that were discharged, 14 (53.8%) were lost to follow up at 3 months. Conclusion and Recommendation: Acute glomerulonephritis is the commonest cause of AKI seen in this study. Majority were discharged but a significant number of them were lost to follow up. Preventive strategies at all levels of care still remains paramount.

[1]

Bellomo R, Kellum JA, Ronco. Acute kidney injury. Lancet 2012; 380: 756- 766.

[2]

Lameire N, Van Biesen W, Vanholder R. Epidemiology of acute kidney injury in children worldwide, including developing countries. Pediatr Nephrol. 2017; 32: 1301-1314.

[3]

Olowu WA, Adelusola KA. Pediatric acute renal failure in southwestern Nigeria. Kidney Int. 2004; 66 (4): 1541-8. https://doi.org/10.1111/j.1523-1755.2004.00918.x PMID: 15458449.

[4]

Lewington AJ, Cerda J, Mehta RL. Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney Int. 2013; 84 (3): 457-67. https://doi.org/10.1038/ki.2013.153 PMID: 23636171

[5]

Cerda J, Bagga A, Kher V, Chakaravarti RM. The contrasting characteristics of acute kidney injury in developed and developing countries. Nat Clin Pract Nephrol 2008; 4: 138-151.

[6]

Li PK, Burdmann EA, Mehta RL. Acute kidney injury: global health alert. Kidney Int 2013; 83: 372-376.

[7]

Odetunde OI, Okafor HU, Uwaezuoke SN, Ezeonwu BU, Ukoha OM. Renal replacement therapy in children in the developing world: challenges and outcome in a tertiary hospital in southeast Nigeria. The Scientific World Journal. 2014; 903151. https://doi.org/10.1155/2014/903151 PMID: 25436234.

[8]

Ogunlesi TA, Adekanmbi F. Evaluating and managing neonatal acute renal failure in a resource-poor setting. Indian journal of pediatrics. 2009; 76 (3): 293-6. https://doi.org/10.1007/s12098-009-0055-8 PMID: 19347669

[9]

Anochie IC, Eke FU. Acute renal failure in Nigerian children: Port Harcourt experience. Pediatr Nephrol 2005; 20: 1610–1614.

[10]

Esezobor CI, Ladapo TA, Osinaike B, Lesi FEA. Paediatric acute kidney injury in a tertiary hospital in Nigeria: prevalence, causes and mortality rate. PLoS One 2012; 7: e51229 doi: 10.1371/journal.pone.0051229 PMCID: PMC3519588.

[11]

Anigilaje EA, Adebayo AI, Ocheni SA. Acute kidney injury in children: A study of etiology, clinical profile, and short-term outcomes at the University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria. Saudi J Kidney Dis Transpl [serial online] 2019 [cited 2019 Oct 5]; 30: 421-39. Available from: http://www.sjkdt.org/text.asp?2019/30/2/421/256849

[12]

Olowu WA, Niang A, Osafo C, Ashuntantang G, Arogundade FA, Porter J, et al. Outcomes of acute kidney injury in children and adults in sub-Saharan Africa: a systematic review. The Lancet Global health. 2016; 4 (4): e242±50. https://doi.org/10.1016/S2214-109X(15)00322-8 PMID: 27013312.

[13]

Ladapo TA, Esezobor CI, Lesi FE. Pediatric kidney diseases in an African country: prevalence, spectrum and outcome. Saudi J Kidney Dis Transplant 2014; 25: 1110–1116.

[14]

Okoli A. Nigeria: Government Urged to Increase Coverage of Kidney Treatment in NHIS. Vanguard 2019. Available from https://allafrica.com/stories/201904090389.html accessed on 02/03/2020.

[15]

National Health Insurance Scheme portal. Benefits package. Available from http://www.nhis.gov.gh/benefits.aspx accessed on 04/03/2020.

[16]

Abdullahi K, Abubakar U, Adamu T, Daneji AI, Aliyu Ru, Jiya NM, Ibraheem MTO. Nata`ala SU Malaria in Sokoto, North Western Nigeria. Afr J Biotechnol. 2010; 8: 7101–7105.

[17]

NM Jiya, UM Sani, FB Jiya and B Ameh. Prevalence of uncomplicated malaria in a Paediatrics outpatient department of a tertiary health institution in Sokoto, Nigeria. Sahel Medical Journal, January- March, 2010; 13: 29-34.

[18]

Raji MIO, Ibrahim YKE. Prevalence of waterborne infections in Northwest Nigeria: A retrospective study. J Public Health Epidemiol. 2011; 3 (9): 382–385.

[19]

Raji MO, Abdullahi U, Raji IA, Oladigbolu RA, Kaoje AU, Awosan KJ. Caregivers' knowledge, home treatment of diarrhoea disease and predictors of child diarrhoea disease in a semi urban community of Sokoto, North-West, Nigeria. J Public Health Epidemiol 2017; 9: 16-23.

[20]

Mungadi IA, Ntia IO, Opara WE, Sani AA. Urolithiasis in Sokoto, North-Western Nigeria. Sahel Med J 2006; 9: 10-14.

[21]

Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012; 2: 1–138.

[22]

National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Chronic Kidney Disease In Children and Adolescents: Evaluation, Classification and Stratification. Available at: http://pediatrics.aappublications.org/content/111/6/1416.full.html. Accessed on 25/02/2020; 1-11.

[23]

Oyedeji GA. Socio-economic and cultural background of hospitalized children in Ilesha. Nig J Paediatr. 1985; 12: 111-117.

[24]

Antwi S, Sarfo A, Amoah A, Appia AS, Obeng E. Acute kidney injury in children: 3-year data review from Ghana. Int J Pediatr Res 2015; 1: 2.

[25]

Halle MP, Lapsap CT, Barla E, et al. Epidemiology and outcomes of children with renal failure in the pediatric ward of a tertiary hospital in Cameroon. BMC Pediatr 2017; 17: 202.

[26]

Imani PD, Odiit A, Hingorani SR et al. Acute kidney injury and its association with in-hospital mortality among children with acute infections. Pediatr Nephrol 2013; 28: 2199–2206.

[27]

Ademola AD, Asinobi AO, Adewuyi EE, Ayede AI, Ajayi SO, Raji YR. Acute kidney injury among paediatric emergency room admissions in a tertiary hospital in South West Nigeria: a cohort study. Clinical Kidney Journal, 2018, 1–6.

[28]

Nigeria Data Portal. Socioeconomic statistics. Available from http://www.nigerianstat.gov.ng/ accessed on 23/01/2019.

[29]

Thomas ME, Blaine C, Dawnay A, Devonald MA, Ftouh S, et al. The definition of acute kidney injury and its use in practice. Kidney Int 2015; 87: 62-73.

[30]

Sawhney S, Fluck N, Marks A, Prescott G, Simpson W, et al. Acute kidney injury-how does automated detection perform? Nephrol Dial Transplant 2015; 30: 1853-1861.

[31]

McLean B, Zimmerman JL. Recognition and assessment of the seriously ill patient in; Fundamental Critical Care Support; Society of Critical Care Medicine 2007; 4: 1-10.

[32]

Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, et al. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int 2007; 71: 1028–1035.

[33]

McGregor TL, Jones DP, Wang L et al. Acute kidney injury incidence in non -critically ill hospitalized children, adolescents, and young adults: a retrospective observational study. Am J Kidney Dis 2016; 67: 384–390.

[34]

Malaria Atlas Project. The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Available from: http://www.nature.com/nature/journal/v526/n7572/full/nature15535. Accessed on 22/01/2020; 207-11.

[35]

Alebiosu CO, Ayodele OE. The global burden of chronic kidney disease and the way forward. Ethn Dis 2005; 15: 418-423.