Evaluation of Acute Kidney Injury (AKI) due to Urosepsis in a Tertiary Care Hospital

Abstract

Background: Urosepsis is associated with significant morbidity and mortality and remains one of the leading causes of acute kidney injury (AKI) in nephrology, urology, and intensive care unit (ICU) settings. Aim of Study: To evaluate the clinical characteristics, microbiological profile, and severity of acute kidney injury, antimicrobial sensitivity, resistance patterns, and treatment outcomes among patients with urosepsis-associated AKI. Methods: This prospective observational study was conducted over a three-year period from January 2023 to December 2025. Patients aged 15–80 years of both sexes attending the inpatient and outpatient departments of Nephrology were enrolled. Result: Patients with AKI secondary to urosepsis were identified according to the kidney disease: Improving Global Outcomes (KDIGO) criteria and included in the study. A total of 200 patients were enrolled. Urosepsis was defined as the presence of acute pyelonephritis or pyonephrosis with bacterial growth in blood cultures consistent with the organism isolated from urine cultures. Among a patient with Urosepsis; Upper UTI was observed in 78% cases and lower UTI was in 22% patients. The major types of cUTI were acute pyelonephritis (56%) then acute complicated cystitis (25%), acute emphysematous pyelonephritis (3%), pyonephrosis (5%) were detected. Among the patients, 60% were mild AKI, 15% moderate AKI, 10% was severe AKI, 10% AKI on CKD, and 5% were dialysis-dependent, while the remaining patients had other grades of renal impairment. The most frequent anatomical abnormalities were posterior urethral valve (PUV), urethral stricture, vesicoureteral reflux (VUR), Autosomal Dominant Polycystic Kidney Disease (ADPKD), and pelvic kidney. Diabetes mellitus was the most common comorbidity among patients with complicated urinary tract infection (cUTI). Escherichia coli (E. coli) was the predominant pathogen, isolated in 44% of cases. Among the Gram-positive organisms, Staphylococcus aureus was the most frequently isolated, accounting for 8% of cases. The antibiogram showed that E. coli was most sensitive to colistin, meropenem, and tigecycline (88.5%). Staphylococcus aureus showed the highest sensitivity to linezolid (90%), followed by vancomycin (80%). Pseudomonas was most sensitive to imipenem (90%) and amikacin (70%). Klebsiella showed the highest sensitivity to piperacillin–tazobactam (95%), followed by meropenem (85%). Enterococcus was most sensitive to amoxicillin–clavulanic acid (80%) and levofloxacin (76%). Proteus showed 75% sensitivity to meropenem. Staphylococcus saprophyticus was most sensitive to linezolid (80%), followed by vancomycin (75%). Group B Streptococci showed the highest sensitivity to meropenem (85%) and amoxicillin–clavulanic acid (70%). Treatment response was not uniform, the study found that a 14-days antibiotic course provided better clinical outcomes compared to a 10-days treatment. Conclusion: Urosepsis-induced Acute Kidney Injury (AKI) is a severe, life-threatening complication that significantly increases short-term mortality and long-term risk of chronic kidney disease (CKD). It requires immediate source control, antibiotic therapy, and hemodynamic stabilization to prevent irreversible end-organ damage.

Journal of Paediatric Surgeons of Bangladesh (2026) Vol. 17 (1): 88-94