Clinical characteristics, risk predictors and outcomes of community-acquired acute kidney injury in children

Background; Little data exist related to community-acquired acute kidney injury (CA-AKI) in children. We aimed to determine the etiology, clinical profile, risk factors, and outcomes of children hospitalized for CA-AKI. Methods; Patients, 1month to18 years, who had CA-AKI on or within 48 hours of hospital admission between January 2020 to June 2025 were included. KDIGO 2012 criteria were used for the diagnosis of AKI. The patients were divided into four groups according to their age; 1 month − 2 years, > 2–6, > 6–12, > 12–18 years. Demographic, clinical, and laboratory data were analyzed. Risk factors for severe CA-AKI (stage 2 and 3) were investigated. Results; 134 patients, male/female ratio; 1.23, with a median age of 10 years (2 months-17.9 years) were included. The most affected age group was > 12 to 18 years (39.6%). Intrinsic CA-AKI accounted for 72% of all cases, mostly glomerular and acute tubulointerstitial diseases. More than half of the patients (65.7%) developed severe AKI. Risk factors for severe CA-AKI were younger age (p = 0.04, OR;1.064, 95%CI:1.002–1.129), intrinsic AKI (p < 0.001, OR; 4.714, 95%CI:2.089–10.639), hyponatremia (p = 0.05, OR;2.114, 95%CI:0.978–4.570), thrombocytopenia (p = 0.003, OR;5.471, 95%CI:1.772–16.895), hyperphosphatemia (p = 0.02, OR;5.727, 95%CI:1.264–25.958) and hyperuricemia (p < 0.001, OR;5.217, 95%CI;2.321–11.730). At discharge, complete recovery was observed in 85%, and partial recovery in 14.8%. Three patients (2.4%) developed CKD. Mortality occurred in 6 (4.5%). Conclusions; Glomerular and tubulointerstitial diseases were the most common causes of CA-AKI, and short term kidney outcomes were favorable. Intrinsic etiology, serum electrolyte disturbances, thrombocytopenia and hyperuricemia were strong independent risk factors for severe CA-AKI.