Paediatric acute kidney injury in a tertiary hospital in Nigeria: prevalence, causes and mortality rate.

BACKGROUND: The modest decline in child mortality in Africa raises the question whether the pattern of diseases associated with acute kidney injury (AKI) in children in Nigeria has changed.

METHODS: A database of children, aged between one month and 16 years, with AKI (using modified pediatric RIFLE criteria) was reviewed. The cause of AKI was defined as the major underlying disease. The clinical and laboratory features of children with AKI who survived were compared to those who died.

RESULTS: Of the 4 015 children admitted into Lagos University Teaching Hospital between July 2010 and July 2012, 70 episodes of AKI were recorded equalling 17.4 cases per 1000 children. The median age of the children with AKI was 4.8 (range 0.1-14.4) years and 68.6% were males. Acute kidney injury was present in 58 (82.9%) children at admission with 70% in 'failure' category. Primary kidney disease (38.6%), sepsis (25.7%) and malaria (11.4%) were the commonest causes. The primary kidney diseases were acute glomerulonephritis (11) and nephrotic syndrome (8). Nineteen (28.4%) children with AKI died. Need for dialysis [odds ratio: 10.04 (2.94-34.33)], white cell >15 000/mm(3) [odds ratio: 5.72 (1.65-19.89)] and platelet <100 000/mm(3) [odds ratio: 9.56 (2.63-34.77)] were associated with death.

CONCLUSION: Acute kidney injury is common in children admitted to hospitals. The common causes remain primary kidney diseases, sepsis and malaria but the contribution of sepsis is rising while malaria and gastroenteritis are declining. Acute kidney injury-related mortality remains high.