Community- versus hospital-acquired acute kidney injury in hospitalised COVID-19 patients

Abstract Background Acute kidney injury (AKI) is a recognised complication of coronavirus disease 2019 (COVID-19), yet the reported incidence varies widely and the associated risk factors are poorly understood. Methods Data was collected on all adult patients who returned a positive COVID-19 swab while hospitalised at a large UK teaching hospital between 1st March 2020 and 3rd June 2020. Patients were stratified into community- and hospital-acquired AKI based on the timing of AKI onset. Results Out of the 448 eligible patients with COVID-19, 118 (26.3 %) recorded an AKI during their admission. Significant independent risk factors for community-acquired AKI were chronic kidney disease (CKD), diabetes, clinical frailty score and admission C-reactive protein (CRP), systolic blood pressure and respiratory rate. Similar risk factors were significant for hospital-acquired AKI including CKD and trough systolic blood pressure, peak heart rate, peak CRP and trough lymphocytes during admission. In addition, invasive mechanical ventilation was the most significant risk factor for hospital-acquired AKI (adjusted odds ratio 9.1, p < 0.0001) while atrial fibrillation conferred a protective effect (adjusted odds ratio 0.29, p < 0.0209). Mortality was significantly higher for patients who had an AKI compared to those who didn’t have an AKI (54.3 % vs. 29.4 % respectively, p < 0.0001). On Cox regression, hospital-acquired AKI was significantly associated with mortality (adjusted hazard ratio 4.64, p < 0.0001) while community-acquired AKI was not. Conclusions AKI occurred in over a quarter of our hospitalised COVID-19 patients. Community- and hospital-acquired AKI have many shared risk factors which appear to converge on a pre-renal mechanism of injury. Hospital- but not community acquired AKI was a significant risk factor for death.

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Preoperative Risk and the Association between Hypotension and Postoperative Acute Kidney Injury

Anesthesiology ◽

10.1097/aln.0000000000003063 ◽

2020 ◽

Vol 132 (3) ◽

pp. 461-475 ◽

Cited By ~ 9

Author(s):

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Validation Cohort ◽

Kidney Injury ◽

Preoperative Risk ◽

Intraoperative Hypotension

Abstract Background Despite the significant healthcare impact of acute kidney injury, little is known regarding prevention. Single-center data have implicated hypotension in developing postoperative acute kidney injury. The generalizability of this finding and the interaction between hypotension and baseline patient disease burden remain unknown. The authors sought to determine whether the association between intraoperative hypotension and acute kidney injury varies by preoperative risk. Methods Major noncardiac surgical procedures performed on adult patients across eight hospitals between 2008 and 2015 were reviewed. Derivation and validation cohorts were used, and cases were stratified into preoperative risk quartiles based upon comorbidities and surgical procedure. After preoperative risk stratification, associations between intraoperative hypotension and acute kidney injury were analyzed. Hypotension was defined as the lowest mean arterial pressure range achieved for more than 10 min; ranges were defined as absolute (mmHg) or relative (percentage of decrease from baseline). Results Among 138,021 cases reviewed, 12,431 (9.0%) developed postoperative acute kidney injury. Major risk factors included anemia, estimated glomerular filtration rate, surgery type, American Society of Anesthesiologists Physical Status, and expected anesthesia duration. Using such factors and others for risk stratification, patients with low baseline risk demonstrated no associations between intraoperative hypotension and acute kidney injury. Patients with medium risk demonstrated associations between severe-range intraoperative hypotension (mean arterial pressure less than 50 mmHg) and acute kidney injury (adjusted odds ratio, 2.62; 95% CI, 1.65 to 4.16 in validation cohort). In patients with the highest risk, mild hypotension ranges (mean arterial pressure 55 to 59 mmHg) were associated with acute kidney injury (adjusted odds ratio, 1.34; 95% CI, 1.16 to 1.56). Compared with absolute hypotension, relative hypotension demonstrated weak associations with acute kidney injury not replicable in the validation cohort. Conclusions Adult patients undergoing noncardiac surgery demonstrate varying associations with distinct levels of hypotension when stratified by preoperative risk factors. Specific levels of absolute hypotension, but not relative hypotension, are an important independent risk factor for acute kidney injury. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Serum chloride and sodium concentration as a predictor of acute kidney injury in premature newborns

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh161124090t ◽

2017 ◽

Vol 145 (7-8) ◽

pp. 340-345

Author(s):

Drazenka Todorovic ◽

Vesna Stojanovic ◽

Aleksandra Doronjski

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Gestational Age ◽

Neonatal Intensive Care ◽

Significant Risk ◽

Kidney Injury ◽

Significant Risk Factor ◽

Sodium Concentration ◽

Premature Newborns ◽

Serum Chloride

Introduction/Objective. Hyperchloremia is often registered in adults? studies after administration with 0.9% sodium chloride, which contributes to the development of acute kidney injury (AKI) as it leads to vasoconstriction of renal blood vessels. The aim of this study was to determine the correlation of sodium and chloride imbalance with the development of AKI, with consideration of other risk factors for this disorder. Methods. This retrospective study included 146 randomly selected preterm infants hospitalized at the Neonatal Intensive Care Unit from 2008 to 2015. Results. Among the patients registered for the study, 23.97% developed AKI, and they were of a significantly lower gestational age (26.3 ? 2.8 weeks vs. 31.7 ? 2.90 weeks, p < 0.05); birth weight (971.31 ? 412.1 g vs. 1,753.3 ? 750.3 g, p < 0.05); Apgar score in the first (3.2 ? 1.7 vs. 5.7 ? 2.4, p < 0.05) and fifth minute (5.3 ? 1.7 vs. 7.1 ? 1.8, p < 0.05) of life compared to those without AKI. The neonates with AKI had significantly higher maximum chloremia (Clmax: 114.1 ? 8.4 vs. 111.7 ? 4.6, p = 0.029) and maximum natremia (Namax: 147.9 ? 8.8 vs. 142.9 ? 4, p < 0.05). Each of these parameters is (independently) a statistically significant risk factor for the development of AKI, and gestational age is the strongest (OR = 1 / 0.643 = 1.55; 95% CI 1.24?1.94). Mortality in neonates with AKI was higher than in neonates without AKI (19.4% vs. 92.7%, p < 0.05). Conclusion. Hyperchloremia and hypernatremia are more common in the premature newborns with AKI compared to the premature newborns without AKI. Higher maximum sodium and chloride values are independent risk factors for AKI.

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Urinary Tract Infection due to Extended-Spectrum Beta-Lactamase Producing Organisms is a Risk Factor for Acute Kidney Injury among Patients with Type 2 Diabetes Mellitus

Journal of Medicine ◽

10.3329/jom.v19i1.34840 ◽

2017 ◽

Vol 19 (1) ◽

pp. 40-43 ◽

Cited By ~ 1

Author(s):

Muhammad Abdur Rahim ◽

Palash Mitra ◽

Ariful Haque ◽

Shahana Zaman ◽

Tabassum Samad ◽

...

Keyword(s):

Acute Kidney Injury ◽

Urinary Tract Infection ◽

Risk Factor ◽

Urinary Tract ◽

Significant Risk ◽

Kidney Injury ◽

Significant Risk Factor ◽

Beta Lactamase ◽

Type 2 Diabetic

Background: Urinary tract infection (UTI) is common and diabetic patients are at increased risk for UTI. UTI may be complicated by acute kidney injury (AKI). This study was designed to evaluate whether UTI due to extend ed-spectrum beta-lactamase (ESBL) producing organisms should be considered as a risk factor for AKI in type 2 diabetic subjects.Methods: This case-control study was done in a tertiary care hospital in Dhaka, Bangladesh from April to June 2016. Type 2 diabetic subjects with culture proven UTI were evaluated. Patients with UTI complicated by AKI were cases and those without AKI were taken as controls. ESBL-positivity of the isolated organisms was evaluated as risk factor for AKI.Results: During the study period, a total of 131 (male to female ratio 1:2.6) type 2 diabetic subjects with culture proven UTI were enrolled. Mean age and mean duration of diabetes were 56.1±13.3 and 8.7±5.4 years respectively. Escherichia coli (82, 62.6%) was the commonest aetiological agent followed by Klebsiella pneumoniae(14, 10.7%). Two-thirds (55/82, 67.1%) of E. coli and two-fifths (6/14, 42.9%) of Klebsiellae were ESBL-positive. UTI in 64 (48.9%) patients were due to ESBL-positive organisms. Out of 131 UTI patients, 62 (47.3%) had AKI; 40 (40/64, 62.5%) among ESBL-positive and 22 (22/67, 32.8%) among non-ESBL organisms. There were no significant difference in relation to age (p=0.71), sex (p=0.26), duration of diabetes (p=0.37) and glycated haemoglobin (HbA1c) (p=0.69) between cases and controls. ESBL-positivity appeared as a significant risk factor for AKI among the study subjects (OR=3.4, 95% CI=1.66-6.99, p=0.008).Conclusions: Almost half of the type 2 diabetic subjects with UTI had ESBL-positive organisms as aetiological agents in this study. UTI due to ESBL-positive organisms was a significant risk factor for AKI.J MEDICINE Jan 2018; 19 (1) : 40-43

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Risk factors for urethral gonorrhoea infection among heterosexual males in Melbourne, Australia: 2007–17

Sexual Health ◽

10.1071/sh19027 ◽

2019 ◽

Vol 16 (5) ◽

pp. 508 ◽

Cited By ~ 4

Author(s):

Tiffany R. Phillips ◽

Christopher K. Fairley ◽

Marcus Y. Chen ◽

Catriona S. Bradshaw ◽

Eric P. F. Chow

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Odds Ratio ◽

Health Centre ◽

Significant Risk ◽

Significant Risk Factor ◽

The Past ◽

High Prevalence ◽

Low Prevalence ◽

Over Time

Background Since 2014 there has been an increase in gonorrhoea among heterosexuals in Australia. Sex with a partner from a country with high gonorrhoea prevalence has been identified as a risk factor for gonorrhoea in heterosexual females, but risk factors for heterosexual males remain unclear. This study determined risk factors for gonorrhoea among heterosexual males. Methods: Retrospective analysis was performed among heterosexual males attending Melbourne Sexual Health Centre (MSHC) between 1 January 2007 and 31 December 2017. Countries for overseas sexual partners were stratified as high-prevalence countries (HPC) or low-prevalence countries (LPC) based on the incidence of gonorrhoea. Results: The annual gonorrhoea positivity increased from 0.72% in 2007 to 1.33% in 2017 (Ptrend <0.001). Males attending MSHC as a contact of gonorrhoea had the highest odds of testing positive (adjusted odds ratio (aOR) 7.46; 95% confidence interval (CI) 4.46–12.49), followed by males identifying as Aboriginal and Torres Strait Islander (aOR 2.57; 95% CI 1.30–5.09), males who had injected drugs in the past 12 months (aOR 2.44; 95% CI 1.39–4.30) and males who had sex with a female from an HPC (aOR 2.18; 95% CI 1.77–2.68). Males aged ≥35 were at higher risk than those aged ≤24 years (aOR 1.44; 95% CI 1.14–1.82). Gonorrhoea positivity increased among males who had sex with females from an LPC (from 0.60% to 1.33%; Ptrend = 0.004) but remained the same over time among males who had sex with females from an HPC (2.14%; Ptrend = 0.143). Conclusions: There was an 80% increase in urethral gonorrhoea among heterosexual males between 2007 and 2017. Having sex with a female from an HPC is a significant risk factor for gonorrhoea. Gonorrhoea positivity among men having sex with a female from an HPC did not change over time, suggesting this risk factor has become less important.

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Association of Preoperative Diuretic Use With Early Acute Kidney Injury in Infants With Biventricular Hearts Following Cardiac Surgery

Journal of the American Heart Association ◽

10.1161/jaha.120.020519 ◽

2021 ◽

Author(s):

Steven L. Rathgeber ◽

Adrija Chakrabarti ◽

Eva Kapravelou ◽

Nicole Hemphill ◽

Christine Voss ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Risk Factor ◽

Cardiopulmonary Bypass ◽

Tetralogy Of Fallot ◽

Odds Ratio ◽

Congenital Heart ◽

Kidney Injury ◽

Stage 1

Background Diuretics are used to manage congestive heart failure in infants with congenital heart disease. Adult data indicate that preoperative diuretic use increases the risk of cardiac surgery associated acute kidney injury (CS‐AKI). We have sought to understand if preoperative diuretics in infants increases the risk of CS‐AKI. Methods and Results This is a single‐center retrospective study of infants (1–12 months) who had CS requiring cardiopulmonary bypass between 2013 and 2018. The diagnosis and severity of CS‐AKI was defined according to the Kidney Disease Improving Global Outcomes guidelines. Three hundred patients were included (mean 6 months, SD 2.4, range 1.2–12.9 months). A total of 149 (49.7%) patients were diagnosed with CS‐AKI (stage 1: 80 [54%], stage 2: 57 [38%], stage 3: 12 [8%]). Logistic regression analysis showed preoperative diuretics were not associated with CS‐AKI (odds ratio [OR], 0.79; 95% CI, 0.43–1.44; P =0.45). A diagnosis of tetralogy of Fallot was an independent risk factor for CS‐AKI (OR, 3.49; 95% CI, 1.33–9.1, P =0.01). A diagnosis of tetralogy of Fallot (OR, 3.6; 95% CI, 1.28–10.22; P =0.02) and longer cardiopulmonary bypass (OR, 1.01; 95% CI, 1.0–1.02; P =0.04) time are risk factors for moderate to severe CS‐AKI. Conclusions Preoperative diuretic use does not contribute to the risk of CS‐AKI in infants early after surgery. A diagnosis of tetralogy of Fallot was the only risk factor for CS‐AKI identified using multivariate analysis in our cohort. Furthermore, a diagnosis of tetralogy of Fallot and longer cardiopulmonary bypass time are risk factors for moderate to severe CS‐AKI.

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Epidemiology of acute kidney injury and associated factors among patients with malignancy: Analysis of hospital inpatient database in Shanghai, China

Journal of Onco-Nephrology ◽

10.1177/2399369319830096 ◽

2019 ◽

Vol 3 (1) ◽

pp. 39-48 ◽

Cited By ~ 2

Author(s):

Yang Li ◽

Xiaohong Chen ◽

Yimei Wang ◽

Jiachang Hu ◽

Jiarui Xu ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cancer Patients ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Kidney Injury ◽

Injury Incidence ◽

Hospital Inpatient ◽

Acute Kidney Injury Stage ◽

Hospital Acquired ◽

Inpatient Database

Objective: This study aimed to understand the incidence of acute kidney injury in cancer patients, to figure out which clinical factors could increase the risks of acute kidney injury, and then to assess the effect of acute kidney injury on in-hospital mortality, length of stay, and hospital cost. Methods: This study was designed as a retrospective cohort study based on the hospital inpatient database in Zhongshan Hospital, Shanghai, China. Patients with malignancy and admitted to the hospital between 1 October 2014 and 30 September 2015 were recruited. Data on demographics, comorbidities, and clinical records were exported for analysis. Acute kidney injury was diagnosed using KDIGO (Kidney Disease: Improving Global Outcomes) criteria and stratified into community-acquired and hospital-acquired acute kidney injury. Multivariate model and survival analysis were applied to discover the influencing factors of acute kidney injury among cancer patients. Results: Of the 26,914 eligible cancer admissions, 3326 acute kidney injury cases were identified with an incidence of 12.4%. Of them, 2961 patients located in acute kidney injury stage 1 and another 365 cases developed to stage 2–3. The highest rates were localized to renal cancer (27.3%), multiple myeloma (24.1%), and leukemia (23.9%). Patients with older age and hematologic cancer shared a higher acute kidney injury incidence. Pre-existing chronic kidney disease (adjusted odds ratio = 7.14), heart failure (adjusted odds ratio = 4.20), surgery/chemotherapy (adjusted odds ratio = 0.99/2.28), hyponatremia (adjusted odds ratio = 2.84), hypokalemia (adjusted odds ratio = 2.42), and hyperuricemia (adjusted odds ratio = 2.62) were the major factors associated with acute kidney injury. In-hospital mortality for acute kidney injury patients was 5.1% as compared with those without acute kidney injury (0.8%). Survival analysis reveals that the risk of death was higher among patients with hospital-acquired acute kidney injury (adjusted hazard ratio = 4.50) and severe acute kidney injury stage (adjusted hazard ratio = 2.68/3.91). Furthermore, the length of stay (13.5 days) and hospital cost (45,066 CNY) were significantly greater in patients with community-acquired acute kidney injury. Conclusion: Acute kidney injury was common in cancer patients and associated with an ominous outcome. Pre-existing comorbidities, electrolyte disturbances, and abnormal biochemical were the predicting factors for acute kidney injury incidence. Better monitoring of electrolytes, identification of high-risk patients, and early acute kidney injury diagnosis should be considered as a priority during anti-cancer treatment.

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Hypernatremia is a Significant Risk Factor for Acute Kidney Injury After Subarachnoid Hemorrhage: A Retrospective Analysis

Neurocritical Care ◽

10.1007/s12028-014-0067-8 ◽

2014 ◽

Vol 22 (2) ◽

pp. 184-191 ◽

Cited By ~ 14

Author(s):

Avinash B. Kumar ◽

Yaping Shi ◽

Matthew S. Shotwell ◽

Justin Richards ◽

Jesse M. Ehrenfeld

Keyword(s):

Acute Kidney Injury ◽

Risk Factor ◽

Subarachnoid Hemorrhage ◽

Retrospective Analysis ◽

Significant Risk ◽

Kidney Injury ◽

Significant Risk Factor

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Comorbidity and severity-of-illness risk adjustment for hospital-onset Clostridioides difficile infection using data from the electronic medical record

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1344 ◽

2020 ◽

pp. 1-7

Author(s):

Stephanie M. Cabral ◽

Katherine E. Goodman ◽

Natalia Blanco ◽

Surbhi Leekha ◽

Larry S. Magder ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Risk Adjustment ◽

Community Hospital ◽

Significant Risk ◽

Significant Risk Factor ◽

Bivariate Analysis ◽

Patient Admissions ◽

Clostridioides Difficile ◽

Risk Adjustment Model

Abstract Objective: To determine whether electronically available comorbidities and laboratory values on admission are risk factors for hospital-onset Clostridioides difficile infection (HO-CDI) across multiple institutions and whether they could be used to improve risk adjustment. Patients: All patients at least 18 years of age admitted to 3 hospitals in Maryland between January 1, 2016, and January 1, 2018. Methods: Comorbid conditions were assigned using the Elixhauser comorbidity index. Multivariable log-binomial regression was conducted for each hospital using significant covariates (P < .10) in a bivariate analysis. Standardized infection ratios (SIRs) were computed using current Centers for Disease Control and Prevention (CDC) risk adjustment methodology and with the addition of Elixhauser score and individual comorbidities. Results: At hospital 1, 314 of 48,057 patient admissions (0.65%) had a HO-CDI; 41 of 8,791 patient admissions (0.47%) at community hospital 2 had a HO-CDI; and 75 of 29,211 patient admissions (0.26%) at community hospital 3 had a HO-CDI. In multivariable regression, Elixhauser score was a significant risk factor for HO-CDI at all hospitals when controlling for age, antibiotic use, and antacid use. Abnormal leukocyte level at hospital admission was a significant risk factor at hospital 1 and hospital 2. When Elixhauser score was included in the risk adjustment model, it was statistically significant (P < .01). Compared with the current CDC SIR methodology, the SIR of hospital 1 decreased by 2%, whereas the SIRs of hospitals 2 and 3 increased by 2% and 6%, respectively, but the rankings did not change. Conclusions: Electronically available patient comorbidities are important risk factors for HO-CDI and may improve risk-adjustment methodology.

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Incidence and risk predictors of acute kidney injury among HIV-positive patients presenting with sepsis in a low resource setting

BMC Nephrology ◽

10.1186/s12882-021-02451-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Davis Kimweri ◽

Julian Ategeka ◽

Faustine Ceasor ◽

Winnie Muyindike ◽

Edwin Nuwagira ◽

...

Keyword(s):

Acute Kidney Injury ◽

Significant Risk ◽

Kidney Injury ◽

Significant Risk Factor ◽

Hiv Positive ◽

Volume Depletion ◽

Adjusted Risk ◽

Adjusted Analysis ◽

Resource Setting ◽

Risk Predictors

Abstract Background Acute kidney injury (AKI) is a frequently encountered clinical condition in critically ill patients and is associated with increased morbidity and mortality. In our resource-limited setting (RLS), the most common cause of AKI is sepsis and volume depletion. Sepsis alone, accounts for up to 62 % of the AKI cases in HIV-positive patients. Objective The major goal of this study was to determine the incidence and risk predictors of AKI among HIV-infected patients admitted with sepsis at a tertiary hospital in Uganda. Methods In a prospective cohort study, we enrolled adult patients presenting with sepsis at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda between March and July 2020. Sepsis was determined using the qSOFA criteria. Patients presenting with CKD or AKI were excluded. Sociodemographic characteristics, physical examination findings, and baseline laboratory values were recorded in a data collection tool. The serum creatinine and urea were done at admission (0-hour) and at the 48-hour mark to determine the presence of AKI. We performed crude and multivariable binomial regression to establish the factors that predicted developing AKI in the first 48 h of admission. Variables with a p < 0.01 in the adjusted analysis were considered as significant predictors of AKI. Results Out of 384 patients screened, 73 (19 %) met our inclusion criteria. Their median age was 38 (IQR 29–46) years and 44 (60.3 %) were male. The median CD4 T-cell count was 67 (IQR 35–200) cells, median MUAC was 23 (IQR 21–27) cm and 54 (74.0 %) participants were on a regimen containing Tenofovir Disoproxil Fumarate (TDF). The incidence of AKI in 48 h was 19.2 % and in the adjusted analysis, thrombocytopenia (Platelet count < 150) (adjusted risk ratio 8.21: 95 % CI: 2.0–33.8, p = 0.004) was an independent predictor of AKI. Conclusions There is a high incidence of AKI among HIV-positive patients admitted with sepsis in Uganda. Thrombocytopenia at admission may be a significant risk factor for developing AKI. The association of thrombocytopenia in sepsis and AKI needs to be investigated.

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Risk factors for hypertensive crisis in children with acute glomerulonephritis

Paediatrica Indonesiana ◽

10.14238/pi56.2.2016.101-6 ◽

2016 ◽

Vol 56 (2) ◽

pp. 101

Author(s):

Sherly Yuniarchan ◽

Risky Vitria Prasetyo ◽

Ninik Asmaningsih Soemyarso ◽

Mohammad Sjaifullah Noer

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Risk Factor ◽

Pediatric Population ◽

Hypertensive Crisis ◽

Significant Risk ◽

Significant Risk Factor ◽

P Value ◽

Acute Glomerulonephritis ◽

Female Ratio

Background Hypertensive crisis occurs in 1-4% of the hypertensive pediatric population, mostly due to acute glomerulonephritis (AGN). Some factors have been suggested to affect blood pressure (BP) in children, such as age, sex, race/ethnicity, obesity, and socioeconomic status, but little is known for risk factors for hypertensive crisis in AGN.Objective To analyze the risk factors for hypertensive crisis in children with AGN.Methods Retrospectively, we studied possible risk factors for hypertensive crisis in children with AGN at Dr. Soetomo Hospital from 2007 to 2011. Hypertensive crisis was defined as systolic BP ≥180 mmHg or diastolic BP ≥120 mmHg (for children ≥ 6 years of age); and systolic and/or diastolic BP >50% above the 95th percentile (for children aged <6 years). We evaluated the demographic and clinical characteristics as potential risk factors. Statistical analysis was done with Chi-square, Fisher’s exact, and logistic regression tests. Variables with P <0.25 in the univariable analysis were further analyzed by the multivariable logistic regression model. A P value of < 0.05 was considered statistically significant.Results There were 101 children included (mean age 9.7 (SD 2.17) years), with a male-to-female ratio of 2.7:1. Hypertensive crisis occurred in 42 (41.6%) children, of whom 8 had hypertensive urgency and 34 had hypertensive emergency. Proteinuria was seen in 53 children with AGN (52.5%) and was the significant risk factor for hypertensive crisis in our subjects (OR=2.75; 95%CI 1.16 to 6.52; P=0.021). Gender, clinical profiles, ethnicity, nutritional status, blood urea nitrogen (BUN), and glomerular filtration rate (GFR) were not significant risk factors for hypertensive crisis.Conclusion Proteinuria is the significant risk factor for hypertensive crisis in children with AGN.

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