Abstract

Introduction: In low- and middle-income countries, Acute Kidney Injury (AKI) in children is associated with increased morbidity and mortality.

Objective: To study the incidence, clinical profile and short-term outcomes of community-acquired acute kidney injury in hospitalized children in Ouagadougou, Burkina Faso.

Patients and methods: We conducted a three-year retrospective study from October 31, 2018, to September 30, 2021. All pediatric inpatients, aged 29 days to 15 years, who met the Kidney Disease Improving Global Outcomes (KDIGO) 2012 criteria for AKI were included.

Results: A total of 41 children were included, with an incidence of 13.66 cases per 1000 hospitalizations. The mean age was 6.89 ± 7 years, with a sex-ratio of 2.15. Fever was present in 85.36% of patients. Diarrhea and vomiting, as well as oliguria/anuria, were present in 31.71% of cases. Mean blood urea nitrogen and serum creatinine levels were 31.14 ± 19.72 mmol/L and 764.42 ± 440.22 μmol/L, respectively. All patients had stage 3 AKI. The main etiologies of AKI were malaria (58.53%) and sepsis (19.51%). Seventeen (41.46%) patients underwent hemodialysis sessions, the primary indications for which were azotemia (88.23%) and severe metabolic acidosis (70.58%). Children who received hemodialysis were significantly older (p=0.033) and had higher mean plasma creatinine (p=0.003) and hemoglobin levels (p=0.029) at admission. At discharge, complete renal recovery was observed in 36.58% of patients. The in-hospital mortality rate was 4.88%.

Conclusion: In our setting, community-acquired AKI was stage 3 in all children and of infectious origin in the majority of cases. Conventional hemodialysis was the only renal replacement therapy available due to resource constraints.

Keywords

Community-Acquired Acute Kidney Injury; Children; Burkina Faso

Introduction

Acute kidney injury (AKI) is a syndrome characterized by a sudden decrease in the Glomerular Filtration Rate (GFR), leading to the retention of nitrogenous waste products and an imbalance in hydroelectrolytic and acid-base homeostasis [1,2].

Its global incidence is approximately 13 million cases per year, 85% of which occur in low-income countries [3]. Most of these countries are located in tropical and subtropical zones, where environmental conditions favor the occurrence of infectious diseases.

AKI affects 26% of hospitalized children [4] and is associated with increased morbidity and mortality, as well as prolonged hospital stay [1,2]. Children with AKI have a five times higher mortality rate than those without it [4]. Among the five continents, Africa records the highest number of deaths, with a child AKI-associated mortality rate of 15% [4].

A distinction is made between community-acquired AKI (present upon hospital admission or within the first 48 hours) and hospitalacquired AKI (occurring at least 48 hours after admission) [2,5]. Community-acquired AKI is the most frequent but remains the least studied [5]. In resource-limited countries, it accounts for 80% of AKI cases [6] and is generally caused by treatable and preventable diseases such as infections or volume depletion [1,7]. In contrast, AKI in developed countries is mainly hospital-acquired, affecting children admitted to intensive care units in the context of multi-organ failure [1,7].

Although AKI is usually reversible when diagnosed and managed early, long-term sequelae such as chronic kidney disease and hypertension can sometimes persist in children [7,8].

In Burkina Faso, as in other low-income countries, the diagnosis and management of AKI are hindered by an insufficient number of kidney disease specialists and by limitations in technical facilities. To our knowledge, no study had been conducted on community-acquired AKI in children in our country. In this context, this study aimed to describe the clinical, paraclinical and the outcomes of communityacquired AKI in children, and to identify factors associated with treatment with hemodialysis.

Patients and Methods

Study design, setting and population

This retrospective single centre study was conducted over a period of three years, from 31 October 2018 to 30 September 2021, in the Pediatrics and Nephrology and Hemodialysis departments of the Tengandogo University Hospital.

All children aged 29 days to 15 years, hospitalized in the pediatrics department for AKI were included. Children with chronic kidney disease and those referred from other healthcare facilities after more than 48 hours of hospitalization were excluded.

The study protocol was approved by the Ethics Committee at Tengandogo University Hospital and was conducted in accordance with the Declaration of Helsinki.

Data collection

Using referral forms and medical records, we collected sociodemographic data (age, sex, area of residence), mode of admission, reason for hospitalisation, treatment received prior to admission, physical examination data, biological data (blood glucose, blood urea nitrogen, serum creatinine, hemoglobin level, white blood cell and platelet counts, sodium, potassium, calcium, bicarbonate, and C-Reactive Protein (CRP)), and therapeutic data. The length of hospital stay and outcomes such as renal recovery and in-hospital death were also recorded.

Definitions

AKI was defined and staged according to the KDIGO 2012 criteria [9]. As urine output was not available for some patients, only serum creatinine was used. AKI was defined by an increase in serum creatinine of at least 26.5 μmol/L or more within 48 hours, or an increase of at least 1.5 times the baseline serum creatinine [9]. The baseline serum creatinine for children was estimated using a back-calculation method; it corresponded to a GFR of 120 ml/min/1.73 m². As height data was unavailable for some children, the Pottel height-free formula was used to estimate GFR [10]: 107.3/(Serum Creatinine/Q), with Q = 0.0270 x age + 0.2329.

AKI is classified into three stages: Stage 1: an increase in serum creatinine of more than 26.5 μmol/L within 48 hours, or an increase in baseline creatinine of between 1.5 and 1.9 times the baseline value. Stage 2: an increase in baseline creatinine of between 2.0 and 2.9 times. Stage 3: an increase in baseline creatinine of at least three times, and/or a serum creatinine level of at least 353.6 μmol/L, and/or an estimated glomerular filtration rate (eGFR) of less than 35 mL/min/1.73 m², and/ or the initiation of renal replacement therapy [9].

Community-acquired AKI was defined as the presence of AKI upon admission or within 48 hours of hospitalisation [10,11].

At discharge, the patient’s renal function was considered to have recovered “completely” when their serum creatinine level returned to less than 1.5 times the baseline level. Recovery was considered “partial” when the serum creatinine level decreased to a less severe stage of Acute Kidney Injury (AKI), but remained higher than 1.5 times the baseline level. “No recovery” was observed if there was no change in the AKI stage.

Statistical Analyses

Data were analyzed using Epi Info software, version 7.5.1. Quantitative variables were expressed as means ± Standard Deviations (SD), and qualitative variables as counts (percentages). Student’s t-test was used to compare quantitative variables, and a p-value < 0.05 was considered statistically significant.

Results

During the study period, 2507 children aged between 1 and 15 years were hospitalized. Of these, 41 had AKI, representing a frequency of 1.63% and an incidence rate of 13.66 cases per 1000 hospitalisations.

The mean age was 6.89 ± 7 years (range 1-15 years), with 21 children (51.22%) being under 5 years old. Twenty-eight patients (68.28%) were male. All children were referred from peripheral healthcare facilities. Prior to admission to Tengandogo University Hospital, eight patients (19.5%) had received diuretics (furosemide), two patients (4.88%) had received traditional herbal remedies and one patient (2.44%) had received Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) (Table 1).

Parameters	n (%)
Gender
Male	28 (68.29)
Female	13 (31.71)
Area of residence
Urban	25 (60.96)
Semi-urban	13 (31.72)
Rural	3 (7.32)
Medication history
Antibiotics	24 (58.53)
Antimalarial	20 (48.78)
Diuretics	8 (19.51)
Traditional herbal remedies	2 (4.88)
NSAIDs	1 (2.44)
Clinical signs and symptoms
Fever	35 (85.36)
Diarrhea	13 (31.71)
Vomiting	13 (31.71)
Oliguria/anuria	13 (31.71)
Altered consciousness	9 (21.96)
Edema	9 (21.96)
Dyspnea	6 (14.63)
Hematuria	2 (4.88)
AKI stage
1	0
2	0
3	41 (100)
Management of AKI
Conservative	24 (58.54)
Dialysis	17 (41.46)
Outcome
Complete recovery	15 (36.58)
Partial recovery	19 (46.34)
No recovery	3 (7.32)
Discharge against medical advice	2 (4.88)
Death	2 (4.88)

Table 1: Baseline characteristics of the study population (N=41).
AKI: Acute Kidney Injury; NSAIDs: Non-Steroidal Anti-Inflammatory Drugs

The most frequent symptoms were fever (present in 35 patients, or 85.36%) and diarrhea, vomiting and oliguria/anuria (each found in 13 patients, or 31.7%).

The mean blood urea nitrogen and serum creatinine levels at admission were 31.14 ± 19.72 mmol/L (range 10-72.6 mmol/L) and 764.42 ± 440.22 μmol/L (range 144.19-2391.5 μmol/L), respectively. All patients had stage 3 AKI.

The main causes of AKI were infections, malaria (58.53%) and sepsis (19.51%) (Table 2).

Etiology of AKI	n (%)
Malaria	24 (58.53)
Sepsis	8 (19.51)
Low respiratory tract infection	4 (9.76)
Urinary tract infection	3 (7.32)
Meningitis	1 (2.44)
Gastroenteritis	4 (9.76)
Glomerulonephritis	4 (9.76)
Herbal intoxication	1 (2.44)

Table 2: Etiologies of AKI (N=41).

Seventeen patients (41.46%) underwent hemodialysis sessions. All children had a double-lumen femoral catheter for vascular access. The mean number of sessions was 3.4 ± 1.3 (range 1-6 sessions). The commonest indications for hemodialysis were uremia (88.23%), severe metabolic acidosis (70.58%), and persistent anuria (41.17%) (Table 3). Children who underwent hemodialysis were significantly older (p=0.033) and had higher admission serum creatinine (p=0.003) and hemoglobin levels (p=0.029) (Table 4).

Indication for hemodialysis*	n (%)
Uremia	14 (88.23)
Severe metabolic acidosis	12 (70.58)
Persisting anuria	7 (41.17)
Severe hyponatremia	5 (29.41)
Pulmonary edema	5 (29.41)
Severe hyperkaliemia	4 (23.53)
Bleeding	2 (11.76)

Table 3: Indications for hemodialysis (N=17).
*Multiple indications possible.

Parameters	All	Hemodialysis		p-value
	(N=41)
	Mean ± SD	Yes (n=17)	No (n=24)
		Mean ± SD	Mean ± SD
Age (years)	6.89 ± 7 ans	8.06 ± 4.15	5.71 ± 2.68	0.033
Length of hospital stay (days)	18.82 ± 17	16.13 ± 7.41	20.95 ± 21.82	0.421
Urea (mmol/L)	31.14 ± 19.72	33.83 ± 20.59	29.36 ± 20.02	0.49
Creatinine (μmol/L)
At admission	764.42 ± 440.22	1004.73 ± 482.68	594.2 ± 359	0.003
Maximum value	933.63 ± 472.2	1118.3 ± 507.25	761.27 ± 375.66	0.039
At discharge	112.72 ± 110.43	98.69 ± 93.46	125.01 ± 125.15	0.232
eGFR (mL/min/1.73m2)	8.18 ± 6.29	5.83 ± 4.14	9.84 ± 7.07	0.043
Hemoglobin (g/dL)	6.01 ± 2.82	7.08 ± 2.42	5.25 ± 2.89	0.029
White blood cells count (cells/mm3)	16261.9 ± 8293.3	15847.6 ± 7741	16555.4 ± 7741	0.774
Platelets count (cells/mm3)	332,363 ± 163,580	333,400 ± 167,585	331,500±165,040	0.974
Sodium (mmol/L)	130.71 ± 9.29	127.35 ± 7.3	133.08 ± 9.94	0.05
Potassium (mmol/L)	5 ± 0.86	4.95 ± 0.79	5.03 ± 0.92	0.766
Calcium (mmol/L)	1.99 ± 0.4	1.89 ± 0.49	2.05 ± 0.32	0.506
Bicarbonates (mmol/L)	15.19 ± 5.38	13.96 ± 5.36	15.96 ± 5.34	0.506
CRP (mg/L)	65.03 ± 89.33	77.17 ± 125.75	58.18 ± 62.73	0.548

Table 4: A comparison of the clinical and biological data of the dialysis and non-dialysis patient groups.
eGFR: Estimated Glomerular Filtration Rate; CRP: C Reactive Protein; SD: Standard Deviation

The mean hospital stay was 18.82 ± 17 days (range 4-97 days). At discharge, renal function recovered completely in 15 patients (36.58%) while three patients (7.32%) showed no recovery. Two patients died during their stay in hospital, giving an in-hospital mortality rate of 4.88% (Table 1).

Discussion

In our study, the frequency of AKI was 1.63%, with an incidence rate of 13.66 cases per 1000 hospitalisations. While this rate was higher than those reported in Belgium (5.9/1000) [12] and the United States (3.9 /1000) [13], it was lower than rates observed in studies from other low- and middle-income countries [6,14-18]. This disparity could be explained by the fact that AKI was underdiagnosed in children in our study. Since oliguria occurs earlier than elevated serum creatinine, using both parameters together makes the diagnostic criteria for AKI more sensitive [19]. However, we did not use this parameter to define AKI in our study due to missing data on urine output volume in most patients. This approach tends to select severe cases and may miss up to one-third of AKI cases [19], as evidenced by the absence of stages 1 and 2 AKI in our study. This finding is supported by a study which showed that, of patients meeting the oliguric criterion, 67.2% would not have been diagnosed based on serum creatinine alone [20]. The male predominance observed in our study has previously been reported by other authors [6,8,21].

In sub-Saharan Africa, AKI in children is mostly communityacquired and is often secondary to infections, diarrheal diseases, and exposure to environmental toxins or drug toxicity [1,16,21]. Community-acquired AKI characterised by a tendency for serum creatinine levels to decrease during hospitalisation [19], as evidenced by the trend towards normalisation observed in our study. Mean serum creatinine levels decreased from 764.42 ± 440.22 μmol/L at admission to 112.72 ± 110.43 μmol/L at discharge.

In our study, malaria was the leading cause of AKI, which is consistent with the series by Evans, et al., [14] and Mwaba, et al., ,17]. In 2023, Africa accounted for the vast majority (94%) of global malaria cases and (95%) of malaria-related deaths, with most of these affecting children [22]. Burkina Faso was the seventh most affected country worldwide [22]. AKI is a serious malaria-related complication, accounting for around 40% of malaria-attributable mortality [16,23]. Several mechanisms can explain the occurrence of AKI during malaria, including renal hypoperfusion (due to insufficient fluid intake, vomiting or diarrhea), direct renal injury induced by the parasite, and nephrotoxicity related to hemolysis [16,23]. Jaundice which was present in 21.96% of our patients, could be related to hemolysis, a source of nephrotoxic free heme [16]. Herbal intoxication was the cause of AKI in one child (2.44%), as had been observed by other authors [14,17]. The use of herbal remedies is partly a consequence of poverty and low levels of education, and contributes to delays in consultation and treatment.

Diuretics such as furosemide increase the elimination of water and electrolytes by the kidneys [24]. However, they can be detrimental in cases of hypovolemia, sepsis or urinary tract obstruction, as they risk exacerbating renal hypoperfusion and triggering the onset of AKI or exacerbating pre-existing AKI [24]. In our series, eight patients had received diuretic treatment. They should only be prescribed in cases of AKI with fluid and sodium retention, and like NSAIDs, they should be prohibited in cases of hypovolemia [9]. Adherence to these usage precautions is crucial in primary care settings, where the practice of stimulating diuresis with furosemide administration remains common yet often inappropriate.

In our study, all children had severe stage 3 AKI. The severity of the AKI was partly explained by the delay in management, which was likely due to late consultation, poverty and limited technical facilities, as was observed in other studies [6].

In our study, 41.46% of children (n=17) received renal replacement therapy. In developing countries, peritoneal dialysis is the renal replacement therapy of choice in children because it can be used to treat young children and those with hemodynamic instability regardless of their weight [19]. In addition, it’s relatively easy implementation and low cost are further advantages in low-income countries [25].

However, in Burkina Faso, hemodialysis is the only renal replacement therapy available, and we did not have pediatric consumables (dialyzers, lines, and catheters). This explains why children who underwent hemodialysis were significantly older and had higher hemoglobin levels. The early initiation of renal replacement therapy, regardless of the method used, is crucial in reducing mortality from AKI in children [25]. The proportion of children receiving hemodialysis was comparable to that reported by Anigilaje, et al., [26] in Nigeria and Djigita Hagre, et al., [27] in Chad. It was, however, lower than that reported by other authors [6,8,14,21].

The mean hospital stay was 18 days. AKI is associated with prolonged hospital stays and increased costs [1,7]. However, in our study, the use of hemodialysis reduced the length of hospitalisation. In our context, a child’s hospital stay requires the constant presence of an adult carer, which can sometimes lead to a loss of income, depending on their profession. Consequently, 4.88% of patients were discharged against medical advice for socio-economic reasons. The mortality rate for childhood AKI varied between 3% and 20.5% [6-8,14,21]. In our study, the in-hospital mortality rate for childhood AKI was relatively low at 4.88%.

Limitations of the Study

Our retrospective study had missing data, particularly regarding urine output, which may have led to an underestimation of the incidence of AKI. Additionally, the small sample size and single-centre design made it difficult to generalise the results. Further prospective multicentre studies with long-term follow-up of patients after discharge are needed to determine the factors associated with AKI in children and its long-term prognosis.

Conclusion

Community-acquired AKI in children is severe in our setting and is most often of infectious origin. Therefore, most cases of communityacquired AKI in children could be prevented through simple, low- cost measures implemented by basic healthcare workers in primary healthcare facilities, enabling early treatment and referral to specialist hospitals.

Conflict of Interest

None.

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Article Information

Article Type: RESEARCH ARTICLE

Citation: Yabama Aïda LH, Lamoussa TO, Lassina D, Abel G, , Edwige SS, et al. (2025) Community-Acquired Acute Kidney Injury in Hospitalized Children at the University Hospital of Tengandogo (Burkina Faso). Int J Nephrol Kidney Fail 12(1): dx.doi.org/10.16966/2380-5498.260

Copyright: ©2025 Yabama Aïda LH, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication history: 

Received date: 25 Nov, 2025

Accepted date: 30 Dec, 2025

Published date: 10 Jan, 2026