Patterns Of Clinical Presentation, Treatment Modalities And Outcomes In Children Under 5 Years With Acute Kidney Injury At Kenyatta National Hospital

Abstract

Acute kidney injury (AKI) is a multifaceted ailment with clinical signs showing from minor dysfunction of the kidney to total malfunction of the kidney completely. The disorder is a type of emergency which is common in children who visit pediatric emergency units. It is a syndrome of diverse etiology characterized by fast decline of the functioning of the kidney resulting in accumulation of harmful nitrogenous wastes in the body and accumulation of extracellular fluid volume as well as electrolyte imbalance. No studies on the management and outcome of AKI in the children population in Kenya. To establish the patterns of clinical presentation, treatment modalities and outcomes in children under 5 years with acute kidney injury at Kenyatta National Hospital The study used a prospective research design that used quantitative approach to determine the patterns of clinical presentation, treatment modalities and their immediate outcome of children under five admitted with AKI in Kenyatta National Hospital (KNH). Stratified and Convenience sampling was used to recruit a total of 120 children with AKI admitted in pediatrics department KNH. The information was filled in the structured questionnaire. Quantitative data was analyzed using SPSS computer package, version 23. Normally distributed variables were reported as means with standard deviations and compared by Student's t test. Assessment of parents/caregiver socio-demographic identified that, 96.7% were female , 41.2% secondary level education, 43.9% self-employed and 40% earning between Ksh. 10,001 and 20,000. The biographic characteristics of children, 50.4% were female,72% stay with their parents and 51.2% were firstborns. The common clinical presentation found in children included decrease in urine volume (69%), nausea (49.6%), shortness of breath (46.3%) and seizures (36.7%). In medication only clinical intervention, 75% fully recovered, 20.6% were at end-stage renal disease and 4.4% died. Peritoneal dialysis and medication intervention had 92.9% fully recovered, 5% were at end-stage renal disease and 2.1% died. There was statistically significant association in both medication and peritoneal dialysis and medication based on the clinical parameters ( Creatinine, Urea, Na, K+) (p<0.05). Substantial number of children were put on medication only treatment modality compared to combined therapy. This is despite combined therapy showing a better outcome than medication only intervention. This underscores the need to implement combined therapy as the first modality in the treatment of children with acute kidney injury. In addition, to adopt improved mechanisms for early detection of AKI among children to guarantee improved clinical outcomes .