Acute kidney injury in hospitalized children with acute watery diarrhea

Abstract

Introduction Acute watery diarrhea (AWD) remains a significant public health concern. Dehydration is the most critical complication of AWD. It can result in prerenal acute kidney injury (AKI) due to reduced renal perfusion pressure. Prolonged hypoperfusion can lead to intrinsic AKI. AWD-related AKI is associated with increased short-term morbidity and mortality. In the long-term, AKI can predispose to chronic kidney disease and hypertension. This study aimed to identify the frequency, risk factors, and short-term outcomes of AKI among a cohort of children hospitalized with AWD. Patients and methods This prospective study included 100 children with AWD, admitted to hospital during the period from June 2023 to April 2024. Children aged 1 month to 12 years, with persistence of diarrhea within the last 24 h before admission were enrolled. History about symptoms and rehydration therapy before admission was taken. Degree of dehydration was assessed. Serum creatinine was obtained on admission and was monitored daily until discharge. Serum sodium, potassium, venous blood gases and urine examination for protein were done. Patients with AKI were evaluated 3 months after discharge for hypertension, renal impairment and proteinuria. Results On admission, 37% of the patients were diagnosed with AKI. Lack of oral rehydration solution treatment before admission, severe dehydration and severe acidosis were significantly associated with AKI. Patients with AKI had significantly longer hospital stay and more need for pediatric intensive care unit admission. Two (5.4%) patients with AKI died. Three months after discharge, all survivors in the AKI group had normal blood pressure, normal estimated glomerular filtration rate, and no proteinuria. Conclusion AKI is a very common complication among children hospitalized with AWD. Lack of oral rehydration solution treatment before admission, severe dehydration and severe acidosis are independent risk factors for AKI. AKI is associated with increased morbidity and mortality, but its overall short-term outcome of AKI is favorable.