Prevalence and factors associated with acute kidney injury among children aged 6 months – 12 years passing dark urine admitted at Soroti Regional Referral Hospital

Abstract

Background: Acute kidney Injury (AKI) is associated with significant morbidity and mortality especially in low resource settings. Early recognition of patients with possible AKI prior to onset of clinical manifestation is crucial for better treatment outcome hence a need for evidence to guide targeted screening of patients with a risk factor for AKI. We sought to determine the prevalence and factors associated with AKI among children passing dark urine since haemoglobinuria, which presents as dark urine is a known risk factor and cause of AKI. Findings from this study will help clinicians to design targeted renal screening protocols among children who pass dark urine in low resources setting. Study objective: To determine the prevalence and factors associated with AKI among children aged 6month - 12years passing dark urine admitted at Soroti Region Referral hospital (SRRH). Methodology: This was a cross sectional study conducted at SRRH, among children aged 6month to 12years, who presented with a history of passing dark urine. Clinical and laboratory variables were collected. Urine colour was assessed using the Hammer Smith colour urine chart (Appendix VIII). Serum creatinine analysis was done on the day of admission, within 48 hours and at day 7 or discharge. AKI was defined as a ≥ 1.5-fold increase in serum creatinine, which was known or presumed to have occurred within the prior 7 days. Bivariate and multivariate analysis was used to determine factors associates with AKI with p values <0.05 were considered significant.

Results: We enrolled a total of 255 participants with median age (IQR) of 4.0 (2.0-6.58) years. More than half of the participants were males 61.6% (n=157) and 21.2 % (n=54) of participants presented with urine colour grade ≥ 9 on the Hammersmith urine colour chart. The prevalence of AKI was found to be 38% (97 out of 255 participants). Of the 97 participants with AKI, 41 (42.3%) had KDIGO stage I AKI; 27 (27.8%) had KDIGO stage II disease; and 29 (29.9%) KDIGO stage III disease. The factors that were found to be associated with AKI among children passing dark urine include grade of the urine colour ≥ 9 on the Hammer Smith urine colour chart (aOR 3.004 (95% CI 1.55-5.80), P-value 0.001 and reduced urine output (aOR 3.432, 95% CI 1.16-10.13), P-value 0.026.

Conclusion: The prevalence of AKI among children aged 6months – 12years passing dark urine was 38%. It was more likely to occur if a child presented with urine that is profoundly black or “Coca-Cola” coloured or if she /he had history of reduced urine output. Close monitoring of urine output by health workers among children passing dark urine is crucial and targeted screening for AKI among those whose urine is profoundly black and those with reduced urine output should be done. Key words; Children, free cell hemoglobin, Acute kidney Injury, Dark urine