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      Acute Kidney Injury in Severe Trauma Patients; a Record-Based Retrospective Study

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          Abstract

          Introduction:

          Acute kidney injury (AKI) is a common and devastating clinical issue in the community associated with high rates of morbidity and mortality.

          Objective:

          We aimed at estimating the frequency and levels of severity of AKI in trauma patients requiring hospital admission using the RIFLE criteria and assess their outcome.

          Method:

          Our retrospective record based study enrolled data of 80 participants aged 18–59 years who presented to the emergency department of KIMS hospital following an acute traumatic event. Participants with pre-existing renal dysfunction, chronic heart failure and chronic liver disease were excluded. Tests of significance were Chi square and independent sample t test, a p<0.05 was considered statistically significant.

          Results:

          Participants with AKI had significantly lower age (p=0.02) and lower revised trauma score (RTS) (p=0.01). Significant association of AKI with hypotension (p=0.01) and Glasgow coma scale (GCS) (p=0.008) was observed. No association of AKI with gender was observed (p=0.6). None of the AKI patients required renal replacement therapy and all participants attained normal renal function at discharge. Significantly longer mean duration of hospital stay (14.4 days) was observed among AKI patients (p=0.02). Totally, 6.3 % mortality was observed among both participants with and without AKI.

          Conclusion:

          Forty percent of acute trauma patients had AKI (in risk and injury category); but none were in failure, loss or end stage renal disease. No association of AKI and mortality was observed. AKI was associated with age, RTS, hypotension and GCS.

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          Most cited references26

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          Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research.

          Meta-analyses of studies yielding sex-specific risk of potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) indicated that female participants were more likely than male participants to meet criteria for PTSD, although they were less likely to experience PTEs. Female participants were more likely than male participants to experience sexual assault and child sexual abuse, but less likely to experience accidents, nonsexual assaults, witnessing death or injury, disaster or fire, and combat or war. Among victims of specific PTEs (excluding sexual assault or abuse), female participants exhibited greater PTSD. Thus, sex differences in risk of exposure to particular types of PTE can only partially account for the differential PTSD risk in male and female participants. (c) 2006 APA, All Rights Reserved.
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            Acute Kidney Injury: Definition, Pathophysiology and Clinical Phenotypes.

            Acute kidney injury (AKI) is a clinical syndrome that complicates the course and worsens the outcome in a significant number of hospitalised patients. Recent advances in clinical and basic research will help with a more accurate definition of this syndrome and in the elucidation of its pathogenesis. With this knowledge we will be able to conduct more accurate epidemiologic studies in an effort to gain a better understanding of the impact of this syndrome. AKI is a syndrome that rarely has a sole and distinct pathophysiology. Recent evidence, in both basic science and clinical research, is beginning to change our view for AKI from a single organ failure syndrome to a syndrome where the kidney plays an active role in the progress of multi-organ dysfunction. Accurate and prompt recognition of AKI and better understanding of the pathophysiologic mechanisms underlying the various clinical phenotypes are of great importance to research for effective therapeutic interventions. In this review we provide the most recent updates in the definition, epidemiology and pathophysiology of AKI.
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              Epidemiology of acute kidney injury: how big is the problem?

              Acute kidney injury (AKI) is a complication that occurs frequently in hospitalized patients. In this article, we provide an overview of the literature on the epidemiology of AKI in hospitalized patients. The overview is restricted to hospitalized patients, and most emphasis is put on intensive care unit patients. The population incidence of less severe AKI and AKI treated with renal replacement therapy is approximately 2,000-3,000 and 200-300 per million population per year, respectively. These numbers are comparable with the estimates for severe sepsis and acute lung injury. Approximately 4-5% of general intensive care unit patients will be treated with renal replacement therapy, and up to two thirds of intensive care unit patients will develop AKI defined by the RIFLE classification. The incidence of AKI is increasing. Intensive care unit patients with AKI have a longer length of stay and therefore generate greater costs. In addition, AKI is associated with increased mortality, even after correction for covariates. Increasing RIFLE class is associated with increasing risk of in-hospital death. Patients with AKI who are treated with renal replacement therapy still have a mortality rate of 50-60%. Of surviving patients, 5-20% remain dialysis dependent at hospital discharge. AKI has a high incidence, comparable with acute lung injury and severe sepsis, and is associated with higher hospital mortality.
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                Author and article information

                Journal
                Adv J Emerg Med
                AJEM
                Advanced Journal of Emergency Medicine
                Tehran University of Medical Sciences
                2588-400X
                Summer 2019
                27 March 2019
                : 3
                : 3
                : e22
                Affiliations
                [1. ]Department of Emergency Medicine, Kerala Institute of Medical Sciences, Trivandrum, India.
                Author notes
                [* ] Corresponding author: Donnel Don Bosco; Email: dr.donbosco86@ 123456gmail.com
                Article
                AJEM-3-e22
                10.22114/ajem.v0i0.141
                6683585
                31410399
                0c7b24b9-0ece-4fc6-85b8-3fbadd833a21
                © 2019 Tehran University of Medical Sciences

                This open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 License (CC BY-NC 4.0).

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                Categories
                Original Article

                acute kidney injury,glasgow coma scale,hypotension,multiple trauma,trauma severity indices

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