Renal Angina Index-Clinical Tool to Predict Acute Kidney Injury in Patients Admitted in Pediatric Intensive Care Unit: A Prospective Study

Abstract

Introduction: Acute kidney injury (AKI) is an important risk factor associated with a high incidence of morbidity and mortality in critically ill children. Therapy for AKI is limited by the inability to reliably diagnose AKI in early stages. The renal angina index (RAI) may be a good clinical score to predict AKI in these children. The study aimed to predict development of subsequent AKI in children admitted in PICU using RAI score. Methodology: A prospective observational study was conducted in PICU including 280 children between one month to 18 years of age with no history of previous or existing kidney diseases. RAI was assessed on day 0 (within 8 to 12 hours of PICU admission) and positivity was defined as RAI score >8. On day 3, serum creatinine was performed and glomerular filtration rate (eGFR) was calculated using the Schwartz formula. RAI positivity correlated with the presence/absence of AKI on day 3. Duration of PICU stay, need of dialysis, need of inotropic support, duration of mechanical ventilation, and final out come were also studied in relation to RAI score. Results: Out of 280 patients, 58 (20.7%) had RAI score >8 (RAI +ve) on day 0. Out of these 58 RAI positive patients, 38 patients (65.51%) developed AKI on day 3 as compared to only 19 (8.56%) patients out of 222 in RAI negative group (p<0.001). The mean duration of mechanical ventilation was 72.02 ± 83.45 hours and 9.10 ± 25.64 hours in the RAI positive and negative groups, respectively (p<0.001). The mean duration of hospitals stay in the RAI positive group was 6.95 ± 4.33 days when compared to 4.11 ± 1.64 days in the RAI negative group. Mortality was significantly high in the RAI positive group (22.41%) compared to RAI negative group (8.56%). Conclusion: Renal angina index is a simple and effective clinical tool to predict AKI in critically ill pediatric patients. It could be of great importance in the future, especially in developing countries where costly biom

Keywords

• Acute kidney injury, Pediatric intensive care unit, Renal angina index.