Abstract

Introduction: Acute kidney injury (AKI) is a major cause of morbidity and mortality in critically ill children. The incidence of AKI is approximately 10%, with mortality of 11-40%. Traditional methods delay the diagnosis of AKI, and it is essential to combine clinical and laboratory parameters. Renal angina index (RAI) scoring aids in the early recognition of the risk of developing AKI. There are few studies on RAI in children; hence, the present study was undertaken. To determine the proportion of children with positive RAI who develop AKI on day 3. The secondary objective was to measure the association between positive RAI scores and short-term outcomes.

Methods: This hospital-based prospective observational study. All children who met the inclusion criteria and were admitted to the pediatric intensive care unit were included. RAI was calculated on day 0 and AKI development was monitored on day 3. An RAI score of 8 was considered positive.

Results: Of the 93 children, 26 were RAI-positive, among whom 21 (80.77%) developed AKI. The sensitivity of RAI in predicting the development of AKI on D3 was 65.38% [95% confidence interval (CI) 44.33-82.79%], specificity was 88.06% (95% CI 77.82-94.7%) and accuracy was 81.72%. A positive RAI score is independently associated with an increased need for mechanical ventilation and increased mortality.

Conclusion: The RAI score obtained upon admission is a simple yet reliable tool for predicting the development of severe AKI. Positive RAI is also an independent predictor of morbidity and mortality in critically ill children.