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DETEMINATION OF OCCURRENCE OF ACUTE KIDNEY INJURY IN PATIENTS OF TETANUS ADMITTED IN PEDIATRIC ICU

Dr Muhammad Sajid, Dr Ahsan Riaz, Dr Muhammad Tayyab Farid

Objective: Tetanus is possibly a lethal complication but still is a preventable issue. Severity of the problem, cardio-vascular issue, pulmonary & kidney complications lead to the mortality. Acute Kidney Injury is very common & fatal complication due to tetanus. This research work aimed is to find out the rate of occurrence of acute kidney injury in the patients of tetanus administered in a tertiary hospital. Methodology: All the children from one to twelve year of age who got admission in the Pediatric ICU with diagnosis of the tetanus for a period of three years were the part of this research work. We applied PRIFLE (Pediatric risk, injury, failure, loss, end) standard to all the patients of the tetanus to classify them as having the acute kidney diseases or not, on the basis of the ECCL (Estimated Creatinine Clearance). We performed a comparison between the patients of Acute Kidney Injury & Non-Acute Kidney Injury as well as between the survivors of Acute Kidney Injury & non-Acute Kidney Injury survivors. This research work carried out at Pediatric ICU of Allied / DHQ Hospital Faisalabad for the patients suffering from tetanus who go admission March 2016 to June 2019. Results: In the duration of this research work, the enrollment of forty-four tetanus patients carried out. About 32.0% of patients of tetanus developed acute kidney dysfunction in accordance with the standard of PRIFLE. There were total 34.09% (n: 15) deaths among the patients of tetanus in which 9 (60.0%) were present with acute renal injury. Oliguria was in observation in 35.71% (n: 5) patients. All non-survivors of Acute Kidney Injury were present with estimated creatinine clearance less than 50.0% & all patients had the autonomic not stability. Acute renal injury developed in three patients at the end of 1st week, in 4 patients in the mid of 2nd week and in 7 patients in the 3rd week. RRT (Renal Replacement Therapy) like PD (Peritoneal Dialysis) carried out in 4 patients of acute renal injury but this treatment was not able to provide improvement. The value of CRP was greater than fifty in 54.54% (n: 24) patients. We gave the support of ventilator to 85.70 % patients of acute renal injury in comparison with the 66.65 % patients from the non-Acute Kidney Injury group. Conclusion: There are many factors for the development acute renal injury in the patients of tetanus. Most important reasons are tetanus severity, availability of the autonomic non-stability, the dependency on the ventilator & sepsis. The availability of the Acute Kidney Injury has the ability to deteriorate the tetanus outcome regarding rate of survival, duration of stay, health expenses & duration on ventilator. keywords: Acute Kidney Injury, tetanus, methodology, RRT, PD, comparison, acute, deteriorate

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