AKI complicates approximately 5–7% of hospital admission & 30% of admission to I.C.U patients. The risk of AKI is contributed by the acute insult and background morbidity. Acute insult may be in the forms of sepsis and hypoperfusion, toxicity, obstruction, & parenchymal kidney disease. The study was conducted on 112 patients with elevated serum creatinine as per KDIGO guidelines and symptoms suggestive of acute kidney injury in the medical wards at Sir Takhatsinhji General Hospital, Bhavnagar. Background morbidities in the form of elderly, CKD, cardiac failure, liver failure, diabetes mellitus, vascular disease, nephrotoxic medications also contribute to insult.

SUMMARY:

Ø  Clinical spectrum of AKI :

Most common age group was 31 to 40 yrs in this study. The incidence of AKI was more in males than females (1.7:1 ratio). Most common clinical features were oliguria (84.82%), vomiting (82.14%) and diarrhea (50.00%). Co–morbidities found in the decreasing order were DM, HTN and IHD. Oliguric AKI and non–oliguric AKI were seen in 84.82 % and 15.18% respectively.

Ø  Etiology of AKI :

Acute diarrheal disease (50.00%) was the most common cause of AKI, followed by sepsis (21.43%), malaria (10.71%), liver cirrhosis (7.14%) and snakebite (3.57%). Acute diarrheal disease still remains the most common cause of acute kidney injury. Sepsis is another leading cause of AKI. According to AKIN criteria, patients classified into AKIN 1, AKIN 2 and AKIN 3 stages were 33.04%, 25.89% and 41.07% respectively. Almost half of patients presented with AKI on admission and other half developed AKI after admission. 49.11% of patients were detected to have AKI on admission while 50.89% developed AKI after admission. Requirement of dialysis support in our study was 30.36% and were treated by haemodialysis. Haemodialysis become the preferred mode of renal replacement therapy.

Ø  Outcome :

Complete recovery was seen in 81.25% cases and partial recovery was seen in 8.04% cases. In–hospital mortality rate was 10.71%. Paraquat poisoning and aluminum phosphide poisoning induced AKI had the highest in–hospital mortality (100%).