Exploring the Renal Angina Index in Pediatric Intensive Care: Correlations and Clinical Outcomes

The development of acute kidney injury (AKI) in critically ill children is associated with adverse outcomes. Timely identification of children at risk for the development of AKI will help clinicians to apply nephroprotective strategies and improve outcome.

The objective of the study was to assess the ability of renal angina index (RAI) at the time of admission in pediatric intensive care unit to predict the development of Severe AKI on day 3.

Children aged between 2 months and 14 years were included in study. Renal function test was measured at the time of admission and then subsequently every 24 hourly for 3 days, and urine output was measured every 6 hourly. AKI staging was done on day 3 according to the Kidney Disease Improving Global Outcomes criteria. Data were analyzed using SPSS version 21.0 and receiver operator characteristic curve analysis.

Out of 152 participants, 30 (19.7%) developed severe AKI in which seven did not survived. RAI score of >8 was significantly associated with mortality (P < 0.001). There was significant association between RAI score and development of severe AKI on day 3. RAI (area under the curve [AUC] =0.814, sensitivity (Sn) =73.3% and specificity (Sp) =72.1%) outperformed day 1 serum creatinine (AUC = 0.797, Sn = 66.7% and Sp = 83.6%) as a marker of development of severe AKI on day 3.

RAI is better when compared to serum creatinine alone for the development of severe AKI.

RAI performs better than serum creatinine for prediction of severe AKI in PICU patients, however further studies are needed for validation.