Acute kidney injury in tropics

Acute kidney injury (AKI) is the most common nephrological emergency encountered in tropical countries. The reported incidence of AKI in different regions of the world is widely variable. In developed countries, the incidence of hospital-acquired AKI exceeds that of community-acquired AKI by 5–10 times. Poverty, poor sanitation, and climatic conditions aggravate renal disease in the tropics. Tropical infections can lead to AKI by direct invasion of the renal parenchyma with microbial agents, induction of an immune response leading to renal inflammation, or tubular necrosis due to haemodynamic disturbances and at times due to iatrogenic renal injury associated with treatment or prophylaxis against tropical infections. Clinical features may be due to systemic manifestations of the etiology responsible for AKI and the renal manifestations. The mortality due to AKI in tropics at a primary health center may reach up to 80% and it is reported to be between 20% and 30% in the referral hospitals.