Acute Kidney Injury in Children: A 3-Year Retrospective Analysis at Komfo Anokye Teaching Hospital, Ghana

Abstract

Background/Aims: Acute kidney injury (AKI) is a relatively common condition encountered in everyday paediatric practice. It remains a significant contributor to preventable deaths especially in resource constraint regions of the world largely due to lack of dialysis services. AKI remains a significant contributor to the mortality of critically ill children. Mortality outcomes depend on such factors as aetiology, medical setting, co-morbidities, and availability of dialysis therapy.

This 3-year data analysis (2010-2012) was undertaken to determine the aetiology and treatment/mortality outcomes of children with AKI presenting to a Teaching Hospital in Ghana. AKI was defined in this analysis by the RIFLE and KDIGO criteria.

Results: Two hundred and six (206) cases of AKI were recorded over the period out of a total of 664 renal cases.

Haemoglobinuria, obstructive uropathy and tumour infiltration of the kidneys were the leading causes of AKI (37.8%). 9.2% of cases were diarrhoeal-related with glomerulonephritides occurring in 12.1% of cases.

Seventy-one (34.5%) of the 206 AKI cases required dialysis which could only be provided for 25 (35.2%), 16 (64%) of whom survived.

Forty-three (20.9%) children died, while 144 (69.9%) survived.

Thirty-one (72%) of the patients who died needed dialysis.

Conclusion: In comparison to previous studies across the world, there is huge burden of AKI among hospitalized children in Kumasi, Ghana.

Haemoglobinuria and tumour-related conditions accounted for most cases of AKI more than diarrhoea-associated conditions and postinfectious glomerulonephritis as were previously reported or postulated.

Most AKI deaths were related to lack of dialysis service. In view of the less technical requirements compared with other modalities of renal replacement therapy, peritoneal dialysis should be promoted across Africa to curtail needless deaths from AKI.