Background: Acute kidney disease (AKD) represents the transitional state of kidney dysfunction between acute kidney injury (AKI) and chronic kidney disease (CKD), and in hospitalised (indoor) patients it arises from a broad, multifactorial spectrum of prerenal, intrinsic and postrenal insults. The present study was planned to study the spectrum of etiopathogenesis of acute kidney disease in indoor patients at a tertiary care centre of Rajasthan, India.
Materials and Methods: This hospital-based prospective observational study was conducted in the Department of General Medicine, Jaipur National University Institute of Medical Sciences and Research Centre, Jaipur, over 15 months from the date of approval of the college research committee and the ethics committee. One hundred patients aged more than 18 years with acute kidney injury attending the outpatient department or admitted to the wards/intensive care units were enrolled after applying the inclusion and exclusion criteria. Information was collected using a pre-designed, semi-structured proforma, and all patients underwent detailed history, clinical examination and routine laboratory investigations, including complete blood count and renal function tests. Data were analysed using SPSS-25; quantitative variables were expressed as mean ± standard deviation and qualitative data as percentages, with p < 0.05 considered statistically significant.
Results: Of the 100 patients, 63% were males and 37% females, with a mean age of 50.91 ± 14.87 years; 39% were aged above 60 years. The mean body mass index was 22.32 ± 2.14 kg/m². Diabetes was present in 45%, hypertension in 33% and coronary artery disease in 23% of patients. Decreased urine output (67%) was the most common presenting feature, followed by hypotension (63%), swelling (60%) and fever (57%). Sepsis was present in 46% and oliguria in 67% of patients. The mean blood urea, serum creatinine and eGFR were 93.42 ± 5.21 mg/dl, 2.56 ± 0.67 mg/dl and 43.21 ± 7.63 ml/min/1.73 m², respectively. Sepsis was the most common etiology of AKI (46%), followed by infections (25%), haemorrhage (15%), poisoning (13%) and drug-induced injury (5%). Eighty-two per cent of patients were discharged and 18% expired. Patients who expired had significantly higher blood urea (104.08 ± 8.65 vs 93.72 ± 5.31 mg/dl; p = 0.001) and serum creatinine (4.40 ± 0.49 vs 2.58 ± 0.68 mg/dl; p = 0.001) and significantly lower eGFR (37.29 ± 4.40 vs 42.86 ± 7.77 ml/min/1.73 m²; p = 0.004). Sepsis (77.8% vs 39%; p = 0.003) and oliguria (100% vs 59.8%; p = 0.001) were significantly associated with mortality.
Conclusion: Acute kidney injury predominantly affected older adults with a male predominance and a high burden of comorbidities. Sepsis and oliguria were common and showed a strong, statistically significant association with mortality, while patients who expired had significantly deranged renal parameters. Early identification of high-risk patients—particularly those with sepsis, oliguria and markedly deranged renal parameters—along with prompt and aggressive management, is essential to improve outcomes and reduce mortality in acute kidney injury.