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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2020  |  Volume : 31  |  Issue : 1  |  Page : 294-295
Acute kidney injury among thai pediatric patients with dengue shock syndrome: A re-estimation


1 Sanitation 1 Medical Academic Center, Bangkok, Thailand
2 Dr. D. Y. Patil University, Pune, Maharashtra, India

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Date of Submission11-Jun-2019
Date of Acceptance13-Jun-2019
Date of Web Publication3-Mar-2020
 

How to cite this article:
Joob B, Wiwnaitkit V. Acute kidney injury among thai pediatric patients with dengue shock syndrome: A re-estimation. Saudi J Kidney Dis Transpl 2020;31:294-5

How to cite this URL:
Joob B, Wiwnaitkit V. Acute kidney injury among thai pediatric patients with dengue shock syndrome: A re-estimation. Saudi J Kidney Dis Transpl [serial online] 2020 [cited 2020 Apr 4];31:294-5. Available from: http://www.sjkdt.org/text.asp?2020/31/1/294/279957


To the Editor,

Dengue is an important tropical vector-borne disease. This infection can result in hemor- rhagic complication due to immune-induced thrombocytopenia.[1] In a severe infection, the patient might develop profound shock.[1] This clinical syndrome is namely dengue shock syndrome. If there is no appropriate fluid replacement therapy, high fatality can be expected. An important complication seen in fatal dengue case is renal failure.[2] Acute kidney injury (AKI) is common among patients with dengue. It is necessary that practitioners have to recognize the possibility that dengue might induce nephropathy.[2] Early detection and prompt treatment is important.[2]

For diagnosis of AKI in dengue, it is recently noted that the classification based on conventional definition might result in underdiag- nosis. Based on the report by Malhi et al, the incidence rates by conventional definition, the AKI Network (AKIN) and the Risk, Injury, Failure, Loss of function, End-stage renal disease (RIFLE) criteria, are equal to 4.2%, 14.2%, and 12.6%, respectively.[3] Hence, it can be expected that there will be 10% and 8.4% underdiagnosis if AKIN and RIFLE criteria are used, respectively.

Here, the authors perform a re-estimation on the incidence rate of AKI among Thai pedia- tric patients with dengue shock syndrome. In Thailand, dengue is very common, and dengue-related AKI is an important problem in clinical nephrology. Based on the official data from the National Institute of Child Health, Bangkok, Thailand,[4] the incidence rates of AKI among pediatric patients with dengue shock syndrome are equal to 60% and 4.4% for cases with final fatality and complete recovery, respectively. Based on the data regarding the pitfall of conventional definition, the estimation for predicted incident rate of AKI among Thai pediatric patients with dengue shock syndrome can be performed based on the following formula: “predicted final rate after adjustment = non adjust rate χ correction factor.” Regarding correction factor, the specific factors in case that if AKIN and RIFLE criteria are applied will be equal to 14.2/4.2 and 12.6/4.2, respectively.

Based on the re-estimation, the final expected incidence rates of AKI among pediatric patients with dengue shock syndrome will be equal to 100% and 14.88% for cases with final fatality and complete recovery, respectively (note: the calculated rare for fatal case exceeds 100%, which means that all fatal cases have acute renal kidney injury).

Based on these data, it can be shown that the AKI might be more common than we previously perceived. In any patient with dengue, good fluid replacement therapy is required and closed monitoring for renal function change is very important.[1]

Conflict of interest: None declared.



 
   References Top

1.
Wiwanitkit V. Dengue fever: Diagnosis and treatment. Expert Rev Anti Infect Ther 2010; 8:841-5.  Back to cited text no. 1
    
2.
Wiwanitkit V. Dengue nephropathy: Immuno- pathology and immune complex involvement. Saudi J Kidney Dis Transpl 2016;27:1280-2.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Mallhi TH, Khan AH, Sarriff A, Adnan AS, Khan YH, Jummaat F. Defining acute kidney injury in dengue viral infection by conventional and novel classification systems (AKIN and RIFLE): A comparative analysis. Postgrad Med J 2016;92:78-86.  Back to cited text no. 3
    
4.
Bunnag T, Kalayanarooj S. Dengue shock syndrome at the emergency room of Queen Sirikit National Institute of Child Health, Bangkok, Thailand. J Med Assoc Thai 2011;94 Suppl 3:S57-63.  Back to cited text no. 4
    

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Correspondence Address:
Dr Beuy Joob
Sanitation 1 Medical Academic Center, Bangkok
Thailand
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DOI: 10.4103/1319-2442.279957

PMID: 32129229

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