Clinical characteristic and risk factors of acute kidney injury among adults with dengue viral infections at a tertiary care center

 

 

Abstract              Background: Several mechanisms have been proposed for DF‑induced acute kidney injury (AKI), including direct action by the virus, hemodynamic instability, rhabdomyolysis, and acute glomerular injury. Previous studies have shown great disparity in the incidence of dengue induced AKI ranging from 0.83% to 13.3%. We conducted this study to assess clinical characteristic and risk factors of acute kidney injury among adult patients with dengue viral infection. Material and Methods: Present study was prospective, observational type conducted in Department of Medicine, in patients with age more than 18 years and admitted with primary confirmed diagnosis of dengue viral fever. Results: Incidence of acute kidney injury in present study was 19%. 19-40 years age was most common in total patients (58 %) and in patients without kidney injury (64 %). In AKI group all age-groups had similar contribution. But as age increases incidence of AKI is increasing significantly. With 37 total patients in age group >60 years, 30 patients developed AKI. Male patients had more incidence of AKI (73 %) as compared to female (27 %). Male to female ratio with AKI in present study was 2.7:1. We noted 70%, 25 % and 5 % patients with dengue fever, dengue hemorrhagic fever and dengue shock syndrome. In patients with AKI incidence of dengue fever, dengue hemorrhagic fever and dengue shock syndrome was 15%, 63%, 23%.Mean duration of hospitalization was 5.49±1.16 days in patients with AKI, as compared to days in patients without AKI. Proteinuria and Hematuria was statistically significant in patients with AKI when compared with patients without AKI. Overall 40%, 34% and 26 % incidence noted in grade I, II and III respectively. We noted 66 % patients had complete recovery, while 15 % patient had partial recovery. Total 26 % patients required Renal replacement therapy. 19 % mortality was noted in present study. Conclusion: With rising incidence of dengue in general population, more patients are diagnosed with dengue associated AKI. Elderly patients, male, associated co-morbid condition like diabetes, hypertension and presence of proteinuria are few predictors of AKI.

Key Words: acute kidney injury; dengue viral infection; mortality; predictors for AKI.