An Audit of the Use of Renal Function Tests among Paediatric Mortalities

Background: Acute kidney injury is a frequent and serious complication encountered in critically ill children and is an independent risk factor for mortality. Major causes of childhood mortality in our environment are conditions frequently complicated by kidney failure, yet kidney failure is conspicuously absent in many of the reports. The actual proportion of these critically ill children subjected to renal function tests is not known. In view of the low representation of kidney failure as a cause of mortality in our environment, we sought to know what proportion of critically ill/dying patients had renal functions tests done and to identify any cases of missed diagnosis.

Methods: This was a descriptive study of the mortalities in the Department of Paediatrics, University College Hospital, Ibadan, between August 2004 and May 2006, particularly those due to kidney failure. Data from the departmental mortality database collected on a weekly basis were analyzed.

Results: Out of 4,941 admissions, there were 542 mortalities (age 1day -13 years) giving a mortality rate of 11%. Low birth weight, malaria, severe perinatal asphyxia, meningitis and neonatal tetanus were the leading five causes of death. Over 80% of the mortalities were under-fives.

Serum urea and creatinine levels were documented in only 217(40%) and 49 (9%) of the mortalities respectively. Primary analysis using ante-mortem data showed that 1.8% died from kidney failure; re-analysis based on available results of renal function tests, many obtained post-mortem, ascribed deaths related to kidney failure to at least 6%.

Conclusion: There is a low rate of utilization of renal function tests in the management of critically ill patients in our setting, which might have contributed to the under-reporting of kidney failure. There is an urgent need to improve the monitoring of renal function in at-risk and critically ill patients in order to institute/expedite appropriate treatment. Failure to apply these measures will continue to affect the under-five mortality rate in Nigeria adversely. As cerebrospinal fluid analysis is important in ruling out meningitis in Paediatrics practice, so is serum creatinine monitoring for ruling out AKI at the present, and should be ensured.