Incidence and determinants of acute kidney injury in hospitalised children with nephrotic syndrome: A prospective observational study

Abstract

Acute kidney injury (AKI) is a frequent and clinically important complication in children with nephrotic syndrome (NS), contributing to increased morbidity, prolonged hospitalisation and risk of progression to chronic kidney disease. Data on the incidence and determinants of AKI in paediatric NS, particularly from low- and middle-income settings, remain limited. The study aimed to determine the incidence and risk factors of AKI among hospitalised children with NS. This cohort-based observational study included children aged 1–14 years with NS admitted to a tertiary care centre between January 2023 and June 2024. AKI was defined and staged according to the Kidney Disease: Improving Global Outcomes criteria. NS subtypes were classified as per the Indian Society of Paediatric Nephrology guidelines. Clinical characteristics, NS phenotype, steroid responsiveness, inter current infections and exposure to nephrotoxic medications were prospectively recorded. Factors associated with AKI were evaluated using univariate analysis followed by multivariable logistic regression. Among 145 enrolled children, 59 (40.7%) developed AKI, with most cases occurring within 24 h of admission. Steroid-resistant NS (adjusted odds ratio [aOR] 3.36; 95% confidence interval [CI] 1.15–10.25), intercurrent infection (aOR 1.27; 95% CI 1.11–1.64) and exposure to nephrotoxic antibiotics (aOR 6.13; 95% CI 2.06–19.8) were independently associated with AKI. Fourteen children (9.6%) required renal replacement therapy. Renal recovery at discharge was observed in 85% of cases, while 10% had persistent acute kidney disease on follow-up. AKI is common in hospitalised children with NS, particularly in those with steroid resistance, infection and nephrotoxic drug exposure. Early risk stratification and careful avoidance of nephrotoxins may reduce AKI burden and improve renal outcomes in this vulnerable population.