Acute kidney injury (AKI) in tropical countries is strikingly different from that in countries with a temperate climate. Tropical regions are characterised by year-round high temperatures and the absence of frost, which supports the propagation of infections that can potentially cause AKI. The aetiology and presentation of AKI reflects the ethnicity, socioeconomic factors, and ecological conditions in tropical countries. Apart from infections, other causes of AKI include exposure to animal toxins, ingestion of plant toxins or chemicals, poisoning, and obstetric complications. The low income status, poor access to treatment, and sociocultural practices (use of indigenous medicines) contribute to poor outcomes of patients with AKI. The exact aetiologic diagnosis often cannot be made due to lack of appropriate laboratory services. The epidemiology of AKI in tropical regions is changing over time. Renal replacement therapy is inaccessible to the majority and late presentation with delayed treatment add to the risk for future development of chronic kidney disease. AKI is often the primary cause of chronic kidney disease in the developing world, which increases demand for renal replacement therapy and transplantation. Most causes of AKI in developing countries are preventable and strategies to improve the public health and increased access to effective medical care are the need of the hour. This review offers comprehensive ideas about epidemiology, aetio-pathogenesis, clinical presentation, diagnosis, treatment, and prevention of community-acquired AKI in the tropics, with special reference to the Indian subcontinent. AKI is an under-recognised cause of morbidity and mortality in developing countries and even small, simple interventions could have an impact on its outcome.
The epidemiology of AKI is largely influenced by environmental factors and climatic conditions in tropical regions. Most published data are from single-centre studies conducted in urban areas and might not reflect the true prevalence of AKI. Approximately 0.1–0.25% of all admissions or 6.6 out of 1,000 admissions were for the management of AKI.7,8 The population of patients with AKI in developing tropical countries is younger (30–40 years of age) than that reported in developed temperate countries (60–70 years of age).9 The incidence of AKI is usually about 5–9% inwards and 30–36% in intensive care units. The incidence of AKI was predominantly seen during the months of July–September.
AETIO-PATHOGENESIS, DIAGNOSIS, AND TREATMENT
The causes of AKI in tropical countries can be due to infections, animal and plant toxins, drugs/ poisons, or obstetric complications.10 There are some newly emerging and rare causes for AKI that we commonly encounter. Figure 1 gives the overall aetiology, pathomechanisms, renal histology, and outcome of AKI in the tropics. Table 2 gives the detail regarding diagnostic tests, treatment, and outcome of common aetiologies of AKI.
HHow do you feed someone with acute kidney injury?igh levels of potassium in the blood – in severe cases, this can lead to muscle weakness, paralysis and heart rhythm problems. fluid in the lungs (pulmonary oedema) acidic blood (metabolic acidosis) – which can cause nausea, vomiting, drowsiness and breathlessness.
Rapid onset of hypertension. Rapid decrease in urine output. Seizures, muscle twitching as a result of increasing potassium levels (hyperkalemia) Changes in the electrocardiogram such as elevated or peaked T waves associated with hyperkalemia.