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.

Original languageEnglish
Pages (from-to)725-729
Number of pages5
JournalClinical and Experimental Nephrology
Volume17
Issue number5
DOIs
Publication statusPublished - 10-2013

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Scrub Typhus
Acute Kidney Injury
Odds Ratio
Critical Care
Thrombocytopenia
Creatine Kinase
Logistic Models
Kidney
Rhabdomyolysis
Artificial Respiration
Tertiary Care Centers
Tachycardia
Dyspnea
Chronic Kidney Failure
Renal Dialysis
India
Differential Diagnosis
Fever
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Physiology
  • Nephrology
  • Physiology (medical)

Cite this

Attur, Ravindra Prabhu ; Kuppasamy, Sujatha ; Bairy, Manohar ; Nagaraju, Shankar Prasad ; Pammidi, Nageswara Reddy ; Kamath, Veena ; Kamath, Asha ; Rao, Lakshmi ; Bairy, Indira. / Acute kidney injury in scrub typhus. In: Clinical and Experimental Nephrology. 2013 ; Vol. 17, No. 5. pp. 725-729.
@article{f2fd7a30989d487da4d3f166ecb381ee,
title = "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.",
author = "Attur, {Ravindra Prabhu} and Sujatha Kuppasamy and Manohar Bairy and Nagaraju, {Shankar Prasad} and Pammidi, {Nageswara Reddy} and Veena Kamath and Asha Kamath and Lakshmi Rao and Indira Bairy",
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month = "10",
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Acute kidney injury in scrub typhus. / Attur, Ravindra Prabhu; Kuppasamy, Sujatha; Bairy, Manohar; Nagaraju, Shankar Prasad; Pammidi, Nageswara Reddy; Kamath, Veena; Kamath, Asha; Rao, Lakshmi; Bairy, Indira.

In: Clinical and Experimental Nephrology, Vol. 17, No. 5, 10.2013, p. 725-729.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Acute kidney injury in scrub typhus

AU - Attur, Ravindra Prabhu

AU - Kuppasamy, Sujatha

AU - Bairy, Manohar

AU - Nagaraju, Shankar Prasad

AU - Pammidi, Nageswara Reddy

AU - Kamath, Veena

AU - Kamath, Asha

AU - Rao, Lakshmi

AU - Bairy, Indira

PY - 2013/10

Y1 - 2013/10

N2 - 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.

AB - 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.

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