ORIGINAL ARTICLE Acute kidney injury and its association with in-hospital mortality among children with acute infections Peace D. Imani & Amos Odiit & Sangeeta R. Hingorani & Noel S. Weiss & Allison A. Eddy Received: 27 December 2012 / Revised: 11 May 2013 / Accepted: 6 June 2013 # IPNA 2013 Abstract Background We investigated prevalence of acute kidney injury (AKI) at hospitalization and its association with in-hospital mor- tality among Ugandan children hospitalized with common acute infections, and predictors of mortality among AKI children. Methods We enrolled 2,055 children hospitalized with primary diagnoses of acute gastroenteritis, malaria, or pneumonia. Serum creatinine, albumin, electrolytes, hemoglobin, and urine protein were obtained on admission. Participants were assessed for AKI based on serum creatinine levels. Demographic and clinical data were obtained using a primary care provider survey and medical chart review. Logistic regression was used to determine predictors of in-hospital mortality. Results A total of 278 (13.5 %) of children had AKI on admission; for 76.2 %, AKI was stage 2 (98/278) or stage 3 (114/278) defined as serum creatinine >2- or 3-fold above normal upper limit for age, respectively. AKI prevalence was particularly high in gastroenteritis (28.6 %) and underweight children (20.7 %). Twenty-five percent of children with AKI died during hospitalization, compared to 9.9 % with no AKI (adjusted odds ratio (aOR) 3.5 (95 % CI, 2.2–5.5)). In-hospital mortality risk did not differ by AKI stage. Predictors of in- hospital mortality among AKI children included primary diag- nosis of pneumonia, aOR 4.5 (95 % CI, 1.8–11.2); proteinuria, aOR = 2.1 (95 % CI, 1.0–4.9) and positive human immunode- ficiency virus (HIV) status, aOR 5.0 (95 % CI, 2.0–12.9). Conclusions Among children hospitalized with gastroenter- itis, malaria, or pneumonia, AKI at admission was common and associated with high in-hospital mortality. Keywords Acute kidney injury . Acute infections . Children . Mortality . Uganda Introduction Acute kidney injury (AKI) can develop as a complication of serious acute illnesses. While it is known to be associated with Dr. Imani and Dr. Odiit contributed equally to this paper. Electronic supplementary material The online version of this article (doi:10.1007/s00467-013-2544-2) contains supplementary material, which is available to authorized users. P. D. Imani : N. S. Weiss Department of Epidemiology, University of Washington, Box 357236, Seattle, WA 98195, USA P. D. Imani e-mail: pdimani@u.washington.edu N. S. Weiss e-mail: nweiss@u.washington.edu P. D. Imani : A. Odiit Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda A. Odiit e-mail: amosodiit@hotmail.com S. R. Hingorani : A. A. Eddy Seattle Children’ s Hospital and Research Institute and Department of Pediatrics, University of Washington, 4800 Sandpoint Way NE, A-7931, Seattle, WA 98105, USA S. R. Hingorani e-mail: sangeeta.hingorani@seattlechildrens.org Present Address: A. A. Eddy (*) Department of Pediatrics, University of British Columbia, BC Children’ s Hospital, 2D15-4480 Oak Street, Vancouver BC V6H 3V4, Canada e-mail: allison.eddy@cw.bc.ca Pediatr Nephrol DOI 10.1007/s00467-013-2544-2