Acute kidney injury in scrub typhus.

Abstract

BACKGROUND:

We studied the urinary abnormalities and acute kidney injury (AKI) as per RIFLE criteria in scrub typhus.

METHODS:

A prospective case record-based study of scrub typhus was carried out from January 2009 to December 2010 in a tertiary hospital in South India. Patients were followed up until renal recovery or for at least 3 months after discharge. Univariate, chi-squared tests and multivariate logistic regression analyses were performed to identify the predictors of AKI.

RESULTS:

Scrub typhus was diagnosed in 259 patients. Urinary abnormalities were seen in 147 patients (56.7%) with 60 patients (23.2%) having AKI. All AKI patients had urinary abnormalities and 17 (28.3%) were oliguric. Applying RIFLE (risk, injury, failure, loss, end-stage kidney disease) criteria, R, I, F were present in 23 (38.33%), 13 (21.67%), and 24 patients (40%), respectively. Creatine phosphokinase (CPK) was raised in 33 patients (55%) and hemodialysis was required in 6 patients (10%). The case fatality rate in this study was 2 out of 259 (0.77%), both having AKI and others recovering clinically. Significant predictors of AKI were tachycardia [odds ratio (OR) 2.28], breathlessness (OR 2.281), intensive care requirement (OR 2.43), mechanical ventilation (OR 3.33), thrombocytopenia (OR 2.90) and CPK>80 U/L (OR 1.76) by univariate analysis and intensive care requirement (adjusted OR 2.89) and thrombocytopenia (AOR 2.28) by multivariable logistic regression.

CONCLUSION:

Scrub typhus should be part of the differential diagnosis of acute febrile illness with AKI. AKI in scrub typhus is usually mild, non-oliguric, and renal recovery occurs in most patients. Rhabdomyolysis may be contributory to AKI. Thrombocytopenia and intensive care requirement are significant predictors of AKI in scrub typhus.

• Authors: Ravindra Prabhu Attur, Sujatha Kuppasamy, Manohar Bairy, Shankar Prasad Nagaraju, Nageswara Reddy Pammidi, Veena Kamath, Asha Kamath, Lakshmi Rao, Indira Bairy
• Journal: Clinical and experimental nephrology (Clin Exp Nephrol) Vol. 17 Issue 5 Pg. 725-729 (Oct 2013) ISSN: 1437-7799 [Electronic] Japan
• PMID: 23292176 (Publication Type: Journal Article)

Chemical References

• Biomarkers
• Creatine Kinase

Topics

• Acute Kidney Injury (diagnosis, epidemiology, microbiology, physiopathology, therapy, urine)
• Adult
• Biomarkers (urine)
• Chi-Square Distribution
• Creatine Kinase (urine)
• Female
• Humans
• Incidence
• India (epidemiology)
• Kidney (physiopathology)
• Logistic Models
• Male
• Multivariate Analysis
• Odds Ratio
• Oliguria (epidemiology)
• Orientia tsutsugamushi (isolation & purification)
• Prospective Studies
• Recovery of Function
• Renal Dialysis
• Risk Factors
• Scrub Typhus (diagnosis, epidemiology, microbiology)
• Severity of Illness Index
• Tertiary Care Centers
• Time Factors
• Treatment Outcome