EXPLAINER: What is Acute Kidney Injury?

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Photo taken from the European Society of Intensive Care Medicine (ESICM)

By Patience Loum

Kidneys perform an important function by cleaning blood as it moves through the human system.

Hundreds of thousands of tiny units in your kidneys (called nephrons) filter waste and toxins out of the blood to produce urine, which then flows into the bladder, according to Yale Medicine.

However, there are times there could be a potentially serious problem with the kidneys – a condition know as Acute Kidney Injury (AKI).

This article explains this episode of sudden kidney damage or failure.

The Gambian case

On August 8, 2022, the Epidemiology and Disease Control (EDC) Unit under the Ministry of Health published a situational report on the Acute Kidney Injury (AKI).

The condition was observed among 32 children below 5 years, resulting in the deaths of 28 children.

On 26 July, 2022, the Epidemiology and Disease Control (EDC) unit received a report through the Director of Health Services from a concerned nephrologist (a kidney specialist) of a sudden raise in cases of AKI among children aged 5 months – 4 years.

What is AKI?

“AKI is an abrupt (within hours) decrease in kidney function, which encompasses both injury (structural damage) and impairment (loss of function), Sheriffo M.K. Darboe who works at the EDC wrote in the situation report “Acute Kidney Injury Event in under 5 children”.

Darboe explained that AKI is a syndrome that rarely has a sole and distinct pathophysiology (the functional changes associated with or resulting from disease or injury).

“Many patients with AKI have a mixed etiology (causes or origin) where the presence of sepsis, ischemia and nephrotoxicity often co-exist and complicate recognition and treatment,” he worte.

The condition has been observed in children across four of seven health regions of The Gambia (Western 1, Western 2, Lower River Region, and Central River Region).

A screenshot from the August 8 situational report shows AIK case distribution by health region in The Gambia

Symptoms

Yale Medicine said on its website that there are rarely any symptoms until the condition has progressed to a late stage. However, if there are symptoms, the most common one is a decrease in urine output.

In The Gambia, the EDC said that apart from the sudden failure to pass urine for more than a day, other symptoms could include fever, diarrhea and vomiting.

AKI causes waste products, like creatinine and urea, to build up in one’s blood and can cause significant damage to the rest of the body. “There are multiple levels of kidney injury, varying from mild to severe. In severe cases, your brain, heart, and lungs can be affected, and you can die,” Yale Medicine said in an AKI factsheet.

AKI summary in The Gambia

Number of cases reported to EDC32
Number of samples collected7
Total samples sent to lab7
Total sample pending7
Total death among cases28
Overall case fatality rate87.5%

Source: Gambia’s EDC, Ministry of Health

Causes and response

The Gambia’s National Public Health Laboratory is conducting tests on urine and stool samples, and blood and drug samples have been sent to Centre Anti-Poison du Senegal Hospital de Fann, according to Darboe.

The objective of the response is to identify the cause or source of the event and institute control measures.

Yale Medicince have noted that multiple conditions can cause AKI. Researchers have shown that infection, conditions that cause lack of blood flow to the kidneys, or conditions and medications that damage the kidneys themselves can all cause a sudden kidney function decline.

To be sure, AKI is most common in hospital settings, especially in critical care patients.

What should parents do?

The Ministry of Health urges parents to be observant, and take to the nearest health facility any child under 5 years with sudden failure to pass urine for more than a day with any of the following: fever, diarrhoea or vomiting.

The Edward Francis Small Teaching Hospital, The Gambia’s main referrel hospital, advises parents to not rely on drugs purchased from pharmacies without visiting a health facility.

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