Acute Kidney Injury in Tropical Countries

Abstract

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.