• Jitendra Gawadia, Kirtisudha Mishra, Manish Kumar, and Diganta Saikia.
• Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.
• Indian Pediatr. 2019 Aug 15; 56 (8): 647-652.

ObjectiveTo determine the proportion of children in a pediatric intensive care unit with a positive Day 0 Renal angina index who develop severe acute kidney injury (AKI) on Day 3; and to compare the predictive ability of the index with that of individual markers of renal injury, for the development of severe acute kidney injury.DesignObservational study.SettingPediatric intensive care unit of a tertiary-care hospital.ParticipantsConsecutive children, 1 month to 12 years, admitted in Level 3 pediatric intensive care unit for a minimum of 8 hours, having weight and intake-output records, were eligible. Children known to have chronic kidney disease or already in stage 2/3 acute kidney injury/dialysis were excluded.ProcedureDay 0 Renal angina index was calculated from the product of Risk Group score (Pediatric intensive care admission/Ventilation and inotropy) and Renal Injury score (fluid overload over previous 8 hours or the % fall in estimated creatinine clearance from baseline). Renal angina index ³8 was considered positive.Main Outcome MeasureThe proportion of children with positive Day 0 Renal angina index who develop severe AKI (Kidney Disease Improving Global Outcomes (KDIGO) ≥ Stage 2) on Day 3.ResultsOf 162 enrolled children (median (IQR) age 10.5 (3,39) months), 86 (53%) had positive Renal angina index. On Day 3, a higher proportion of children with positive index developed severe AKI, compared to negative group (RR 95.5; 95% CI 21.7,420.5; P<0.001). Day 0 positive Renal angina index had a sensitivity, specificity, positive predictive value and negative predictive value of 96.9%, 75.5%, 72% and 97.4% respectively, for predicting severe AKI on Day 3. The Receiver Operating Characteristic curve of Day 0 renal angina scores showed AUC of 0.90 (95% CI 0.85, 0.95), better than the AUC obtained from either Day 0 serum creatinine or Day 0 percent fall in estimated creatinine clearance from baseline.ConclusionsDay 0 Renal angina index positivity is a promising tool to identify critically ill children with impending severe AKI.

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