Journal de néphrologie et thérapeutique

The Clinical Pattern and Outcomes of Acute Kidney Injury in a Semi-Urban Hospital Setting in Cameroon

Abstract

Fouda Menye Ebana Hermine Danielle, Tewafeu Denis George, Kombe Frizt, Halle Marie-Patrice, Verla Vincent Siysi, Mahamat Abderraman Guillaume, Kaze Folefack1 and Ashuntantang Gloria

Background: Acute kidney injury (AKI) is a common disorder with high morbi-mortality especially in developing countries. In contrast to high income regions, AKI in these areas tend to be more community-acquired and affect young people. As in most Subsahara countries, previous studies on AKI in Cameroon were carried out in urban tertiary hospitals. Data on the clinical pattern and outcomes in semi-urban is lacking and may be quite different of urban setting. Objective: To describe the clinical pattern and outcomes of AKI in Buea Regional Hospital.
Methods: We conducted an 18 months’ hospital-based observational retrospective study in the regional hospital of Buea, a semi-urban second category health facility of the South-West region of Cameroon. We excluded patients with known CKD (Chronic Kidney Disease)and incomplete data. AKI was diagnosed and classify according to the 2012 KDIGO criteria. Renal outcome was evaluated at 1 month.
Results: Of the 196 participants included, 57.7% were males and 10.7% children. The median age was 45 years. HIV infection, hypertension and diabetes were the main comorbidities. AKI was community-acquired in 95% and stage 3 was found in 59%. Sepsis (37.2%), volume depletion (25%) and nephrotoxicity from herbal remedies (15.3%) were the main etiologic factors. Renal AKI was found in 72% of patient and was mostly due to ATN (56.6%). Obstetrical AKI was mainly due to post-abortum sepsis and AKI related malaria were the main etiology of pediatric AKI. In all, 71 (36%) participants had indications for dialysis but only 52 (73%) accessed it. Lack of appropriate dialysis technique and lack of funds were the main reasons for dialysis non-access. In-hospital mortality was 37.2%. Among survivors, renal recovery was complete in 65%, partial in 21%, and no recovery in 3%. Stage 3 disease was the only predictor of poor renal recovery at one month.
Conclusion: AKI in this semi-urban hospital setting is community acquired and affected young individual with previous comorbidities such as HIV/AID, hypertension and diabetes. It is mainly caused by infections, volume depletion and herbal toxins.