European Journal of Cardiovascular Medicine

Acute kidney injury depicts the abrupt decline in renal function mostly occurs over the course (hours to days) and ends in retention of metabolic waste products and dysregulation of fluid, electrolytes and acid base homeostasis¹. During the past decades acute loss of kidney function previously referred to as acute renal failure has been modified to acute kidney injury with increased recognition of importance of relatively small changes in renal function on short and long term clinical outcomes.

The kidneys being relatively unique among other organs of the body in its ability to recover from almost complete loss of function, AKI may develop in a wide variety of settings including ambulatory, outpatients, hospitalized, & particularly critically ill patients. AKI is associated with substantial morbidity and mortality².

Climate, ethnicity, culture, socioeconomic status, and development status all influences AKI epidemiology. As a result, the epidemiology of AKI varies greatly from country to country and even within the same country. In low-income and middle income countries, characteristics of patients with AKI seen in tertiary care hospitals in large cities are similar to their counterparts in high-income countries: most are elderly, critically ill with multi-organs failure, having chronic co-morbidities, and the main causes of AKI are ischemia, sepsis, and nephrotoxic drugs. On the other hand, AKI seen in small community, rural areas are mostly due to diarrhea, animal venoms, use of native medicines, infectious diseases and low obstetrics care³.

Unfortunately, other than biopsy direct assessment of kidney damage is not achievable with current technology, as a result a variety of urine biomarkers are used or proposed as indicators of glomerular or tubular cell injury. According to Ostermann, in consensus statement released in 2020, damage biomarkers should be included into the concept of AKI to improve its categorization⁴. Importantly in the appropriate clinical context, both functional impairment (serum creatinine level elevation or urine output decline) and the presence of biomarkers indicating structural damage are associated with significant increases in mortality. Although recovery of renal function occurs in the majority of patients surviving an episode of AKI, many patients remain dialysis dependent or are left with severe renal impairment. More recently, it has been recognized that even patients who have complete or near complete recovery of renal function are at increased risk of Chronic Kidney Disease (CKD) and the superimposition of AKI on CKD is associated acceleration in the rate of progression to End Stage Renal Disease (ESRD). AKI complicates 5-7% of acute care hospital admissions and up to 30% of admissions to intensive care unit²_. AKI is associated with increased risk of death in hospitalized patient, particularly in those admitted in ICU where in hospital mortality rate may exceed 50 percent⁵. The patient who survive and recover from an episode of severe AKI and required dialysis are at increased risk for the development of dialysis requiring end stage kidney disease. Therefore, the present study is done with the following aims and objectives of -

1. To study the clinical spectrum of AKI patients
2. To identify the etiology of AKI.
3. To study the outcome of the patients with AKI

STUDY TYPE: Hospital based observational study. STUDY PERIOD: From 1st July 2020 to 30th June 2021 STUDY POPULATION: All patients diagnosed with AKI during the study period. SAMPLE SIZE: To include all patients diagnosed with AKI during the study period. In my study sample size is 110 patients STUDY LOCATION: Gauhati Medical College, Guwahati. SOURCE OF DATA: The clinical material of this study consists of detailed study of patients with AKI admitted in medicine ward Of Gauhati Medical College & Hospital during the period from 1st July 2020 to 30th June 2021. ETHICAL CLEARANCE: Ethical Committee approval was taken from ethical committee, Gauhati Medical College, Guwahati INCLUSION CRITERIA: • All patients fulfilling the criteria in accordance with KDIGO staging for AKI. • Patient more than 12 years. EXCLUSION CRITERIA: • Patient with chronic kidney disease. • Patients with abnormal kidney size and abnormal cortico-medullary differentiation. DATA COLLECTION AND ANALYSIS: Data was collected via interviewing the patient and attendant, thorough physical examination and relevant investigation. Complete blood count, E.S.R, Blood urea, Serum creatinine, Random blood sugar, liver function test, serum electrolytes were done in the central laboratory of the medical college. Ultrasound of the whole abdomen was done in the radiology department, GMCH. Additional laboratory tests were done as per the need of the patient. A written informed consent was taken from all patients and the purpose of the study was explained to them. Patients were allowed to discontinue from study at any time. The study protocol was approved by the institutional ethics committee of Guwahati Medical College and Hospital, Assam, India. All data has been analyzed and compiled using Microsoft Excel, SPSS 21 version in view of objectives of the study. The data was collected from the interviewing of patients and attendants along with the symptoms, physical examination and relevant investigation.