Analyzing Severe Acute Kidney Injury Using the Renal Angina Index

Introduction: Acute kidney injury (AKI) is one of the most common complications in critically ill children admitted to the pediatric intensive care unit (PICU). The Renal Angina Index (RAI) is one of the newer effective tools for predicting AKI. It is assessed at the time of admission to the PICU and is used to determine the risk of subsequent severe AKI. The RAI score may be calculated by combining objective signs of kidney dysfunction and patient risk factors. Objective: This study aims to evaluate the early prediction of severe AKI in patients using the RAI. Methods: This was a prospective observational study conducted in the PICU of the Institute of Medical Sciences and SUM Hospital from 2020 to 2022. Children aged 1 month to 14 years were included. RAI scoring was performed on day 0, and the development of AKI was assessed on day 3. Results: The mean (±SD) age of the study patients was 5.25 (±4.03) years. RAI positivity was seen in 44.9% of patients, of whom AKI developed in 37.7%. A larger proportion of RAI-positive patients required mechanical ventilation (71%) compared with RAI-negative patients (9.6%). The mean (±SD) duration of PICU stay in the RAI-positive group was 10.38 (±10.24) days compared with 6.95 (±4.73) days in the RAI-negative group. The majority of RAI-positive patients developed AKI (32.3% stage 1 AKI, 24.7% stage 2 AKI, and 16.1% stage 3 AKI), which was significant compared with RAI-negative patients (7.9% stage 1 AKI, 0.9% stage 2 AKI, and 0% stage 3 AKI). Mortality was observed in 20.4% of RAI-positive patients versus 7% of RAI-negative patients. Conclusions: The RAI score is a reliable tool for predicting AKI in critically ill children.