ESPN 53rd Annual Meeting

ESPN 2021


 
STUDY OF PREVALENCE AND CLINICAL SPECTRUM OF SEPTIC ACUTE KIDNEY INJURY (SAKI) IN STEROID RESPONSIVE NEPHROTIC SYNDROME
DEBANJAN SINHA 1 SANAT KUMAR GHOSH 1

1- DR. B C ROY PGIPS, KOLKATA, INDIA
 
Abstract:

 Systemic inflammatory response syndrome (SIRS) insult in the nephrotic background initiates interplay between inflammation and oxidative stress, leading to septic acute kidney injury (SAKI). Most paediatric studies are related to AKI in nephrotic syndrome while there is hardly any data on SAKI in steroid-responsive nephrotic syndrome.

 

Objectives:

To study prevalence, clinical spectrum, contributory factors and short term outcome of SAKI in steroid responsive nephrotic syndrome.

 

Methods:

A prospective observational study was done on inpatients  paediatrics department of DR.BC RoyPGIPS  including steroid responsive nephrotic syndrome up to 12 yrs of age. Children with congenital kidney anomaly and immunodeficiency were excluded. pRIFLE criteria were used for AKI while SIRS criteria was used for sepsis.

 

 

Results:

             Among the total 235 admitted steroid responsive nephrotic patients, 64 patients (27.23%) developed AKI while 59 of them had features of SAKI. So, the proportion of SAKI was 92.10% (59 of 64). Severity of AKI was found to be increased as per progression of sepsis to severe sepsis to septic shock. 15.3% SAKI cases were positive for blood culture (M.C.- Pneumococci) while 8.5% positive for urine culture (M.C.- E.Coli). most common presentation were Ascites (93.2%) followed by tachycardia (84.5%). Clinical features included peritonitis or septic shock followed by prolongation of the oliguric phase, development of hypertension, azotemia and congestive heart failure in some cases. Diuresis followed with subsidence of edema, CCF, azotemia. Among 59 SAKI cases, majority (n=14, 23.7%) was frequent relapse nephrotic syndrome (FRNS) followed by 1st relapse (18.7%), 2nd relapse (18.7%). Regarding contributory factors, 52.4 % patients had hypovolemia and 10.17% had prior usage of nephrotoxic drugs. We found that 4 out of 55 patients (7.27%) had features of relapse after 6 months, 10.91% remained hypertensive.

 

Conclusions:

                       Mortality and morbidity are more among SAKI patients with nephrotic syndrome than without SAKI.