Naseem Faizia, Hussain Abid, Arif Fehmina
Faizia Naseem, MBBS, DCH, MCPS, FCPS. Assistant Professor Department of Paediatrics, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
Abid Hussain, MBBS, DCH, FCPS. Assistant Professor Department of Paediatrics, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
Pak J Med Sci. 2018 Mar-Apr;34(2):363-367. doi: 10.12669/pjms.342.14254.
Tetanus is a potentially fatal but preventable disease. Mortality is related to severity of the disease, cardiovascular, pulmonary and renal complications. Acute kidney injury (AKI) is a frequent and lethal complication of tetanus. The objective was to determine the frequency of AKI in tetanus patients managed in a public hospital.
Children aged 1-12 years admitted in Paediatric Intensive Care Unit (PICU) with the clinical diagnosis of tetanus over three and half years were recruited for the retrospective study. pRIFLE (Pediatric Risk, Injury, Failure, Loss, End) criteria was applied to all cases of tetanus to categorize them as having AKI or not, on the basis of estimated creatinine clearance (ECCL). Comparison was done between AKI and non-AKI cases, as well as between AKI survivors and AKI non-survivors. The study was conducted at PICU of Dr. Ruth K.M. PFau Civil Hospital Karachi for tetanus cases admitted during July 2013 to December 2016.
During the study period, 44 patients of tetanus were enrolled. Nearly 32 % of tetanus patients developed acute renal dysfunction according to PRIFLE criteria. There were overall 15 (34.09%) expiries among tetanus patients among which nine (60%) had AKI. Oliguria was observed in five (35.71%) cases. All the AKI non-survivors had ECCL below 50% and all had autonomic instability. AKI developed towards the end of first week in three cases, mid of second week in four cases and third week in seven cases. Renal replacement therapy (RRT) i.e. peritoneal dialysis (PD) was done in four AKI cases but it did not improve the outcome. CRP was more than 50 in 24 (54.54%) cases. Ventilatory support was given to 85.71% with AKI as compared to 66.66% of non AKI patients.
Development of AKI in tetanus is multifactorial. Major contributors are severity of the tetanus itself, presence of autonomic instability, ventilator dependency, and sepsis. Presence of AKI worsens the outcome of tetanus in terms of survival, length of stay, hospital cost and ventilator days.
破伤风是一种潜在致命但可预防的疾病。死亡率与疾病严重程度、心血管、肺部及肾脏并发症相关。急性肾损伤（AKI）是破伤风常见且致命的并发症。目的是确定在一家公立医院接受治疗的破伤风患者中AKI的发生率。
选取在三年半时间里入住儿科重症监护病房（PICU）、临床诊断为破伤风的1至12岁儿童进行回顾性研究。应用pRIFLE（儿科风险、损伤、衰竭、失功、终末期）标准，根据估算的肌酐清除率（ECCL）对所有破伤风病例进行分类，以确定是否发生AKI。对AKI病例与非AKI病例、AKI存活者与AKI非存活者进行比较。该研究在卡拉奇鲁思·K·M·PFau公民医院的PICU进行，研究对象为2013年7月至2016年12月期间收治的破伤风病例。
研究期间，共纳入44例破伤风患者。根据PRIFLE标准，近32%的破伤风患者出现急性肾功能障碍。破伤风患者中共有15例（34.09%）死亡，其中9例（60%）患有AKI。5例（35.71%）出现少尿。所有AKI非存活者的ECCL均低于50%，且均存在自主神经功能不稳定。3例AKI在第一周结束时出现，4例在第二周中期出现，7例在第三周出现。4例AKI患者接受了肾脏替代治疗（RRT），即腹膜透析（PD），但并未改善预后。24例（54.54%）患者的CRP超过50。AKI患者中85.71%接受了通气支持，而非AKI患者为66.66%。
破伤风患者发生AKI是多因素导致的。主要因素包括破伤风本身的严重程度、自主神经功能不稳定、呼吸机依赖和脓毒症。AKI的存在会使破伤风患者在生存、住院时间、住院费用和呼吸机使用天数方面的预后恶化。
