Causes of mortality in patients with acute kidney injury at Mahatma Gandhi Medical (MGM) College and Hospital, Jamshedpur - A tertiary care centre in Jharkhand

Background: Acute kidney injury (AKI), previously called acute renal failure (ARF), is an abrupt loss of kidney function that develops within 7 days. Its causes are numerous. Generally it occurs because of damage to the kidney tissue caused by decreased renal blood flow (kidney ischemia) from any cause such as low blood pressure, exposure to substances harmful to the kidney, an inflammatory process in the kidney, or an obstruction of the urinary tract that impedes the flow of urine. AKI is diagnosed on the basis of characteristic laboratory findings, such as elevated blood urea nitrogen and creatinine, or inability of the kidneys to produce sufficient quantity if urine. Materials and methods: All patients aged above 18 years with features of AKI as per AKIN (Acute Kidney Injury Network) criteria which is defined as an increase in serum creatinine of 0.3 mg/dl or more within 48 hours of observation or 1.5 times baseline or greater, which is known or presumed to have occurred within 7 days, or a reduction in urine volume below 0.5 ml/kg/h for 6 hours were included in this study. A total of 146 patients were included in this study. Results: Causative factors of AKI were decreased renal perfusion, nephrotoxic drugs, septicemia, intravascular hemolysis, hepato-renal syndrome, urinary catheterization and volume depletion. In this study, thirty four deaths out of 146 cases were documented and most common cause was septicemia followed by peripheral circulatory failure and uremia. Most common organisms involved were pseudomonas and acinetobacter. Conclusion: Drug induced AKI can be prevented if used with discretion in patients with associated risk factors. The meticulous and appropriate monitoring of hydration status, fluid and electrolyte imbalance, use of nephrotoxic drugs particularly aminoglycosides, efficient control of infection and sepsis maintenance of adequate diuresis and hydration in surgical settings and patients undergoing radio contrast study are the main steps towards the prevention of hospital acquired acute renal failure.