Prevalence and Clinical Profile of Septic Acute Kidney Injury in Steroid Responsive Nephrotic Syndrome in a Tertiary Care Hospital in Eastern India: A Prospective Observational Study

Acute kidney injury (AKI) and sepsis are well-recognized complications of steroid-responsive nephrotic syndrome. Systemic inflammatory response syndrome (SIRS) initiates inflammation and oxidative stress, which eventually results in septic acute kidney injury (SAKI). A few papers are available in the literature regarding the clinical profile of AKI in nephrotic syndrome; however, there are hardly any data on SAKI in steroid-responsive nephrotic syndrome. Hence, we tried to observe the prevalence and clinical spectrum of SAKI in nephrotic syndrome. A prospective observational study was conducted at DR. B C Roy Post Graduate Institute of Pediatric Sciences, a tertiary care hospital in Kolkata, among children under 12 years of age with steroid-responsive nephrotic syndrome. Patients with any congenital malformation of the kidney and previously associated chronic kidney disease were excluded. EpiInfo 7.2.0.1 of the Centers for Disease Control USA was used for statistical analysis. The total number of participants was 235 nephrotic children. Among 235 participants, 64 (27.23%) nephrotic children developed AKI. Fifty-nine participants out of these 64 children with AKI (92.10%) fulfilled the criteria of SAKI. In the categorization of 59 SAKI patients, 40 (67.8%) children had sepsis, and 19 (32.20%) children had septic shock. Meanwhile, 20.3% (n = 38), 13.6% (n = 12), and 15.3% (n = 9) nephrotic children with SAKI patients developed Stage 1, Stage 2, and Stage 3 AKI, respectively, on Kidney Disease: Improving Global Outcomes (KDIGO) staging. Kidney injury was observed to be more severe with increased severity of sepsis (p-value < 0.000000731). Mortality in SAKI was 8.47%. Duration of hospitalization, requirement of ICU treatment, ventilatory support, and inotrope and renal replacement therapy were more frequent among nephrotic patients developing SAKI. SAKI was found to be the most important complication of steroid-responsive nephrotic syndrome, with higher morbidity and mortality.