Acute kidney injury (AKI) is common in intensive care unit (ICU) and carries a high mortality rate. Reliable and comparable data about the clinical spectrum of AKI is necessary for optimizing management. The study was conducted to describe epidemiology, etiology, clinical characteristics and outcome of AKI in critically ill patients without pre-existing renal disease, diagnosed using RIFLE criteria. We retrospectively analyzed data of 500 adult patients admitted to ICU with AKI or who developed AKI in ICU. Patients with pre-existing renal disease, renal transplant recipients were excluded. AKI was predominantly encountered in older males. Diabetes, hypertension, coronary artery disease were the most commonly prevalent comorbidities. Sepsis was the most common cause of AKI, accounting for 38.6% of patients. 24.4% belonged to risk class, 37.0% to injury class, 35.0% to failure class, 3% to loss and 0.6% to ESRD class of the RIFLE criteria. Renal replacement therapy (RRT) was required in 37.2% (n = 186) of patients. About 60% recovered complete renal function. Chronic kidney disease (CKD) was a sequel in 2.4% (n = 12) of patients. Average duration of ICU stay was 5.6 days. Crude mortality rate was 37.6% (n = 188). In critically ill patients without pre-existing renal disease, elderly age, male sex, type 2 diabetes along with a primary diagnosis of sepsis were most commonly associated with AKI. Majority of the patients’ recovered complete renal function.

Fungal infections are an important cause of morbidity and mortality in renal transplant recipients. The causative agent and the risk factors differ depending on the period after the kidney transplant. Also the incidence varies according to the geographical area. We are reporting three cases of fungal infections in renal transplant recipients. Two of them have etiological agents which are common among immunosuppressed patients, but with an atypical clinical presentation, while one of them is a subcutaneous infection caused by a less frequent dematiaceous fungus, Aureobasidium pullulans. These cases highlight how a high index of clinical suspicion and prompt diagnosis is very much essential for better outcome. The emerging fungal infections and paucity of data regarding their management pose a challenge to the transplant physicians.

Acute kidney injury (AKI) is an independent risk factor for mortality in sepsis syndrome. Few Indian studies have focused on describing the epidemiology of sepsis with AKI. Adult patients with sepsis-induced AKI were evaluated for the clinical characteristics and outcome and to correlate various parameters associated with sepsis to the outcome of patients. This prospective study included 136 patients with sepsis-induced AKI between 2007 and 2009. All patients required renal replacement therapy. Males comprised 44% of the patients while 56% were females; their mean age was 38.6 years. When we compared the survivor and non-survivor groups, it was found that mortality was associated with delayed presentation (6.8 vs 9.4 days), presence of hypotension (132/80 vs 112/70 mmHg), oliguria (300 vs 130 mL), anemia (8 vs 9.3 gm/dL), prolonged prothrombin time (15 vs 29 s) and activated partial thrombin time (38 vs 46 s), creatinine (7.8 vs 6.4 mg/dL), blood urea (161 vs 135 mg/dL), higher D-dimer (1603 vs 2185), short hospital stay (27.9 vs 8.3 days), number of hemodialysis sessions (11.9 vs 6 times), need for vasopressors (14% vs 52%) and ventilator (7.2% vs 75%) and higher Sequential Organ Failure Assessment (SOFA) score (6.7 vs 11.4) (P <0.05). The most com-mon source of infection in this study was urogenital tract (34%). About 51.4% showed complete recovery of renal function. The overall hospital mortality rate was 38.9%. Less than 10% of the patients developed impaired renal function following septic AKI. In conclusion, the most common renal manifestation of sepsis was AKI, which is a risk factor for mortality in sepsis syndrome. SOFA score >11 and multi-organ dysfunction are the risk factors for mortality.

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