Clinical Profile, Risk Factors, and Outcomes of Acute Kidney Injury in Critically Ill Pediatric Patients

Background: Acute kidney injury (AKI) is a frequent complication among critically ill children admitted to intensive care units and is associated with increased morbidity, prolonged hospitalization, and mortality. Early identification of risk factors and predictors of poor outcomes is essential for improving clinical management and survival.

Aim and Objectives: To evaluate the clinical profile, risk factors, severity, management strategies, and outcomes of acute kidney injury among critically ill pediatric patients admitted to a Pediatric Intensive Care Unit (PICU).

Materials and Methods: This prospective observational study was conducted in the Department of Pediatrics, ESIC Medical College and Hospital, Kalaburagi, Karnataka, from April 2025 to March 2026. A total of 100 critically ill children aged 1 month to 18 years diagnosed with AKI according to Kidney Disease Improving Global Outcomes (KDIGO) criteria were included. Demographic details, clinical features, risk factors, laboratory parameters, AKI severity, treatment modalities, and outcomes were recorded. Statistical analysis was performed using SPSS version 26.0. A p-value <0.05 was considered statistically significant.

Results: Among 100 children with AKI, the majority belonged to the 1–5 years age group (32%), with male predominance (61%). Sepsis/septic shock was the most common underlying condition associated with AKI (38%). Common clinical manifestations included fever (72%), oliguria (64%), and respiratory distress (52%). Sepsis (62%), shock (48%), nephrotoxic drug exposure (36%), and mechanical ventilation (34%) were major risk factors. According to KDIGO staging, Stage 1 AKI was observed in 42%, Stage 2 in 34%, and Stage 3 in 24% of patients. Renal replacement therapy was required in 12% of cases, predominantly among Stage 3 AKI patients. Complete renal recovery occurred in 68%, partial recovery in 14%, while mortality was observed in 10% of children. Sepsis, shock, mechanical ventilation, multiorgan dysfunction syndrome, and Stage 3 AKI were significantly associated with mortality (p<0.05).

Conclusion: AKI remains a significant complication among critically ill pediatric patients. Sepsis, hemodynamic instability, mechanical ventilation, MODS, and advanced AKI stage are important predictors of adverse outcomes. Early recognition and aggressive management of high-risk patients may improve renal recovery and reduce mortality