Ravindra Prabhu Attur1, Sujatha Kuppasamy2, Manohar Bairy3, Shankar Prasad Nagaraju3, Nageswara Reddy Pammidi3, Veena Kamath2, Asha Kamath2, Lakshmi Rao4, Indira Bairy5. 1. Department of Nephrology, Kasturba Medical College and Hospital, Manipal, Manipal University, Madhavnagar, Manipal, Udupi District, 576104, Karnataka, India. aravindraprabhu@gmail.com. 2. Department of Preventive and Social Medicine, Kasturba Medical College and Hospital, Manipal, Manipal University, Udupi District, Karnataka, India. 3. Department of Nephrology, Kasturba Medical College and Hospital, Manipal, Manipal University, Madhavnagar, Manipal, Udupi District, 576104, Karnataka, India. 4. Department of Pathology, Kasturba Medical College and Hospital, Manipal, Manipal University, Udupi District, Karnataka, India. 5. Department of Microbiology, Kasturba Medical College and Hospital, Manipal University, Udupi District, Karnataka, India.
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.
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: Anugrah Chrispal; Harikishan Boorugu; Kango Gopal Gopinath; John Antony Jude Prakash; Sara Chandy; O C Abraham; Asha Mary Abraham; Kurien Thomas Journal: Trop Doct Date: 2010-04-01 Impact factor: 0.731
Authors: Gopal Basu; Anugrah Chrispal; Harikishan Boorugu; Kango G Gopinath; Sara Chandy; John Anthony Jude Prakash; Kurien Thomas; Asha M Abraham; George T John Journal: Nephrol Dial Transplant Date: 2010-08-11 Impact factor: 5.992
Authors: Dong-Min Kim; Dae Woong Kang; Jong O Kim; Jong Hoon Chung; Hyun Lee Kim; Chi Young Park; Sung-Chul Lim Journal: J Clin Microbiol Date: 2007-11-14 Impact factor: 5.948