| ORIGINAL ARTICLE |
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| Year : 2020 | Volume
: 14
| Issue : 2 | Page : 99-103 |
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Spectrum and short-term outcome of acute kidney injury in renal allograft recipients: A single-center experience of Northwest India
Shyam Sundar Nowal, Gaurav Shekhar Sharma, Manish Sharma, Dhananjai Agarwal, Rajesh Jhorawat, Rakesh Kumar Gupta, Sanjeev Kumar Sharma, Pankaj Beniwal, Vinay Malhotra
Department of Nephrology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
Correspondence Address:
Dr. Rajesh Jhorawat
Department of Nephrology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijot.ijot_50_19
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Introduction: Acute kidney injury (AKI) episodes in postrenal transplant are important determinants of short- and long-term graft survival. Renal allograft recipients (RARs) are more vulnerable for AKI and differ in risk factor, etiology, and outcome compared to community-setting AKI. The aim of this study was to evaluate the spectrum and the impact of AKI episode on RARs. Materials and Methods: This was a single-center, prospective observational study on 72 RARs (live and cadaveric) with a total of 93 AKI episodes, who were admitted with AKI (as defined by Kidney Disease Improving Global Outcome [KDIGO] criteria) between October 2016 and September 2018 and were followed for 3 months after AKI episodes. Results: A total of 93 AKI episodes occurred in 72 RARs during the study period. The mean age was 36.32 ± 12.03 years and mean serum creatinine at AKI episode was 2.59 ± 0.85 mg/dl. The etiologies of AKI were infections (n = 67, 72.04%), biopsy-proven rejection (n = 10, 10.75%), calcineurin inhibitor toxicity (n = 9, 9.67%), biopsy-proven acute tubular necrosis (n = 3, 3.22%), recurrence of native kidney disease (n = 2, 2.15%), and miscellaneous causes (n = 2, 2.15%). The majority (n = 53, 57.98%) of AKI episodes developed in the 1st year of transplant, 14 (15.05%) between 1st and 2nd year posttransplant, while the rest 26 (27.95%) beyond 2 years. Sixty-nine (74.2%) AKI episodes were in the KDIGO Stage 1, 18 (19.4%) were in Stage 2, and 6 (6.5%) episodes were in Stage 3. At 3 months of follow-up, various factors associated with nonrecovery of renal functions, including multiple AKI episode (P = 0.006), AKI requiring dialysis (P = 0.027), AKI Stage II or III (P = 0.003), and noninfectious etiology (P = 0.027). Overall, AKI had significant impact on renal allograft function at 3 months (P = 0.045). Pulmonary infection (P = 0.016) and need for dialysis (P = 0.001) were associated with increased risk of mortality in RARs after AKI. Conclusion: AKI in RARs had significant impact on renal allograft function and recovery.
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