Journal of Infectious Diseases Acute Kidney Injury In Dengue Fever, One Year Hospital Based Cross Sectional Study. *Corresponding Author: Dr. Akashdeep Singh, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India, Email: akashdp03@gmail.com. Received: 01-Mar-2025, Manuscript No. JOID-4625 ; Editor Assigned: 02-Mar-2025 ; Reviewed: 24-Mar-2025, QC No. JOID-4625 ; Published: 14-Apr-2025, DOI: 10.52338/joid.2025.4625 Citation: Dr. Akashdeep Singh. Acute kidney injury in Dengue Fever, one year Hospital based cross sectional study. Journal of Infectious Diseases. 2025 April; 10(1). doi: 10.52338/joid.2025.4625. Copyright © 2025 Dr. Akashdeep Singh. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ISSN 2831-8064 Research Article Dr. Srikant Yadav, Dr. Dnyanesh N Morkar, Dr. Akashdeep Singh*, Dr. Hima morkar. *KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India. www.directivepublications.org INTRODUCTION Arboviruses pose a significant public health challenge, particularly in tropical and subtropical regions, where they contribute to frequent epidemics with substantial economic and social impacts. Among them, the dengue virus (DENV), transmitted by Aedes mosquitoes, is the most prevalent arthropod-borne viral infection in humans. Dengue fever (DF) has a vast global footprint, with an estimated 2.5 billion people at risk, and outbreaks reported in over 100 countries, primarily in Southeast Asia, the Pacific, and the Americas. While traditionally considered an urban disease, dengue is increasingly affecting rural populations, particularly in Africa and the eastern Mediterranean. Dengue infection presents with a wide spectrum of clinical manifestations, ranging from mild febrile illness to severe dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS), which contribute to significant morbidity and mortality. The disease burden has escalated over the years due to increasing globalization, trade, and travel, leading to the introduction of virulent strains into new regions. Despite preventive measures, dengue remains endemic in many countries, including India, where seasonal outbreaks occur annually, particularly during the monsoon season. In recent years, atypical manifestations of dengue, including neurological, hepatic, and renal complications, have been increasingly recognized. Among these, acute kidney injury (AKI) is a relatively underreported but potentially serious complication. Dengue-related renal involvement may present as AKI, proteinuria, glomerulonephritis, or hemolytic uremic syndrome, necessitating early recognition and intervention. However, data on dengue-associated AKI remain scarce, with only a few case reports and studies available in the literature. Given the recurrent epidemics of dengue and the limited understanding of its renal complications, this study aims to estimate the prevalence of AKI in dengue fever. Identifying such complications is crucial for improving early diagnosis, optimizing patient management, and reducing disease- related morbidity and mortality. OBJECTIVES The objectives of this study were • To study the prevalence of acute kidney injury in dengue fever. • To study the predictors of development of acute kidney injury in dengue fever. METHODOLOGY Study Design and Setting This is a prospective observational study conducted at [Institution/Hospital Name], a tertiary care center in [Location], over a period of [Duration]. The study was designed to estimate the prevalence of acute kidney injury (AKI) in patients diagnosed with dengue fever (DF). Study Population Patients presenting with clinical features of dengue fever and confirmed by laboratory testing were included in the study. The inclusion and exclusion criteria were as follows: Inclusion Criteria 1. Patients aged ≥[Age] years diagnosed with dengue fever based on clinical and serological confirmation (NS1 antigen or dengue IgM/IgG ELISA). 2. Patients with or without complications of dengue fever, including dengue hemorrhagic fever (DHF) and dengue

Directive Publications Dr. Akashdeep Singh shock syndrome (DSS). Exclusion Criteria 1. Patients with pre-existing chronic kidney disease (CKD). 2. Patients with other concurrent infections or conditions known to cause AKI (e.g., sepsis, leptospirosis, malaria). 3. Patients on nephrotoxic drugs before hospitalization. Data Collection A structured proforma was used to collect patient demographics, clinical symptoms, laboratory parameters, and outcomes. The following data were recorded: Demographic details Age, sex, comorbidities. Clinical features Fever, rash, bleeding tendencies, hypotension, oliguria, neurological symptoms. Laboratory investigations • Complete blood count (CBC) • Platelet count • Hematocrit • Liver function tests (LFTs) • Renal function tests (RFTs) (serum creatinine, blood urea nitrogen) • Serum electrolytes • Dengue serology (NS1 antigen, IgM, IgG ELISA) • Urine analysis (proteinuria, hematuria) • Imaging (ultrasound for renal involvement if clinically indicated) Definition of Acute Kidney Injury (AKI) AKI was defined based on the Kidney Disease: Improving Global Outcomes (KDIGO) criteria as follows 1. Increase in serum creatinine by ≥0.3 mg/dL within 48 hours. 2. Increase in serum creatinine to ≥1.5 times the baseline within 7 days. 3. Urine output <0.5 mL/kg/h for more than 6 hours. Patients were categorized into different AKI stages according to the severity of renal involvement. Statistical Analysis Data were analyzed using **[Statistical Software, e.g., SPSS version X or STATA]**. Continuous variables were expressed as mean ± standard deviation (SD) or median (interquartile range, IQR) depending on the distribution. Categorical variables were presented as frequencies and percentages. Chi-square or Fisher’s exact test was used for categorical data, while Student’s t-test or Mann–Whitney U test was used for continuous data. A **p-value <0.05** was considered statistically significant. Ethical Considerations The study was approved by the Institutional Ethics Committee of [Institution Name] (Approval No: [Reference No.]). Informed consent was obtained from all participants before enrollment. Confidentiality of patient data was maintained throughout the study. This methodology provides a clear and structured approach to the study while ensuring scientific rigor and ethical compliance. Let me know if you need any modifications or additions! In the present study 7.18% of the males developed AKI compared to 1.53% of the females and the difference observed was statistically significant (p=0.016). In this study significantly higher number of patients who were aged between 61 to 70 years (52.94%) and 71 to 80 years (50%) developed AKI (p<0.001). In the present study AKI was diagnosed in all the (100%) patients with DSS compared to DHF (4.76%) and DF (4.5%). The difference observed was statistically significant (p<0.001). In the present study significant association was found between serum creatinine at admission and AKI (p<0.001). In the present study 9.02% of the patients with platelet count < 20,000 /cumm developed AKI compared to other counterparts (p=0.026). In this study positive association was found between AKI and blood urea at admission (p<0.001). In the present study no association was found between serositis and AKI (p=0.097). In this study significantly higher of patients with hypotension (28.57% vs 5.49% developed AKI (p<0.001). In this study significantly higher mortality was noted in patients with AKI (100% vs 0%; p<0.001).

RESULTS Table 1. Distribution of patients according to the AKI AKI Distribution (n=535) Number Percentage Present 31 5.79 Absent 504 94.21 Total 535 100.00 In the present study 7.18% of the males developed AKI compared to 1.53% of the females and the difference observed was statistically significant (p=0.016). Page - 2Open Access, Volume 10 , 2025

Dr. Akashdeep Singh Directive Publications Figure 1. In this study 5.79% of the patients developed AKI. Table 2. Association of AKI with sex. AKI Sex Absent Present Total No. % No. % No. % Male 375 92.82 29 7.18 404 100.00 Femle 129 98.47 2 1.53 131 100.00 Total 504 94.21 31 5.79 535 100.00 p = 0.016 In the present study 7.18% of the males developed AKI compared to 1.53% of the females and the difference observed was statistically significant (p=0.016). Table 3. Association of AKI with age. AKI Age group (Years) Absent Present Present No % No % No % 18 to 30 309 97.48 8 2.52 317 100.00 31 to 40 112 94.92 6 5.08 118 100.00 41 to 50 44 88.00 6 12.00 50 100.00 51 to 60 29 96.67 1 3.33 30 100.00 61 to 70 8 47.06 9 52.94 17 100.00 71 to 80 1 50.00 1 50.00 2 100.00 81 to 90 1 100.00 0 0.00 1 100.00 Total 504 94.21 31 5.79 535 100.00 p < 0.001 In this study significantly higher number of patients who were aged between 61 to 70 years (52.94%) and 71 to 80 years (50%) developed AKI (p<0.001). Page - 3Open Access, Volume 10 , 2025

Dr. Akashdeep Singh Directive Publications Table 4. Association of AKI with severity of dengue fever. AKI Severity of dengue fever Absent Present Total No. % No. % No. % Dengue fever 424 95.50 20 4.50 444 100.00 Dengue haemorrhagic fever 80 95.24 4 4.76 84 100.00 Dengue shock syndrome 0 0.00 7 100.00 7 100.00 Total 504 94.21 31 5.79 535 100.00 p < 0.001 In the present study AKI was diagnosed in all the (100%) patients with DSS compared to DHF (4.76%) and DF (4.5%). The difference observed was statistically significant (p<0.001). Table 5. Association of AKI with serum creatinine at admission. AKI Serum creatinine (mg/dL) Absent Present Total No. % No. % No. % < 0.7 95 97.94 2 2.06 97 100.00 0.7 to 1.20 56 70.89 23 29.11 79 100.00 > 1.20 353 98.33 6 1.67 359 100.00 Total 504 94.21 31 5.79 535 100.00 p < 0.001 In the present study significant association was found between serum creatinine at admission and AKI (p<0.001). Table 6. Association of AKI with platelet count at admission. AKI Platelet count (x 103 /cumm) Absent Present Total No. % No. % No. % <20 121 90.98 12 9.02 133 100.00 20 to 49 173 97.74 4 2.26 177 100.00 50 to 99 108 90.76 11 9.24 119 100.00 100 to 150 68 97.14 2 2.86 70 100.00 >150 34 94.44 2 5.56 36 100.00 Total 504 94.21 31 5.79 535 100.00 p = 0.026 In the present study 9.02% of the patients with platelet count < 20,000 /cumm developed AKI compared to other counterparts (p=0.026). Table 7. Association of AKI with blood urea at admission. AKI Blood urea (mg/dL) Absent Present Total No. % No. % No. % <17 163 99.39 1 0.61 164 100.00 17 to 49 15 45.45 18 54.55 33 100.00 > 49 326 96.45 12 3.55 338 100.00 Total 504 94.21 31 5.79 535 100.00 Page - 4Open Access, Volume 10 , 2025

Dr. Akashdeep Singh Directive Publications p < 0.001 In this study positive association was found between AKI and blood urea at admission (p<0.001). Table 8. Association of AKI with serositis. AKI Serositis Absent Present Total No. % No. % No. % Present 245 92.45 20 7.55 265 100.00 Absent 259 95.93 11 4.07 270 100.00 Total 504 94.21 31 5.79 535 100.00 p = 0.097 In the present study no association was found between serositis and AKI (p=0.097). Table 9. Association of AKI with hypotension. AKI Hypotension Absent Present Total No. % No. % No. % Present 5 71.43 2 28.57 7 100.00 Absent 499 94.51 29 5.49 528 100.00 Total 504 94.21 31 5.79 535 100.00 p < 0.001 In this study significantly higher of patients with hypotension (28.57% vs 5.49% developed AKI (p<0.001). Table 10. Association of AKI with mortality. AKI Mortality Absent Present Total No. % No. % No. % Survivor 504 95.09 26 4.91 530 100.00 Non survivor 0 0.00 5 100.00 5 100.00 Total 504 94.21 31 5.79 535 100.00 p < 0.001 In this study significantly higher mortality was noted in patients with AKI (100% vs 0%; p<0.001). DISCUSSION

Dengue infection presents with a wide clinical spectrum, ranging from asymptomatic cases and undifferentiated febrile illness to severe forms such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). While classical dengue fever is characterized by biphasic fever, myalgia, retro-orbital pain, rash, leukopenia, and thrombocytopenia, severe cases may lead to hemorrhagic manifestations, multi-organ dysfunction, and fatal outcomes. As dengue continues to emerge globally, atypical presentations and complications such as acute kidney injury (AKI) are increasingly recognized but may be underreported due to a lack of awareness. Demographic and Clinical Characteristics In our study, males were more commonly affected than females (male-to-female ratio: 3.08:1), consistent with previous studies by Sharma et al. (1998) and Agarwal et al. (2010). The most affected age group was 18–30 years (59.25%), with a mean age of 31.52 years, aligning with findings from AIIMS, Mexico, and other studies. Fever was the universal symptom (100%), followed by myalgia (69.91%), vomiting (67.66%), and nausea (66.92%). Petechiae (25.23%) and retro-orbital pain (18.32%) were also noted. Compared to previous studies, our findings on oliguria were noteworthy, suggesting a possible renal involvement even in early dengue infection. Page - 5Open Access, Volume 10 , 2025

Dr. Akashdeep Singh Directive Publications Imaging Findings Pleural effusion and acute respiratory distress syndrome (ARDS) were noted in 0.93% and 0.53% of patients, respectively, which was lower than the incidence reported by Kumar et al. (2010). Ultrasound findings revealed ascites (47.66%) and gallbladder thickening (40.19%), consistent with prior studies. The gallbladder thickening may be attributed to increased vascular permeability and plasma leakage, a hallmark of severe dengue. Laboratory Parameters and Disease Severity Thrombocytopenia was present in 57.9% of patients at admission, with platelet counts improving over time. Elevated transaminases (SGOT: 92.34%, SGPT: 82.06%) were observed, reflecting hepatic involvement, as seen in previous studies from Delhi and AIIMS. Most patients (82.99%) had classical dengue fever, while 15.7% had DHF, and 1.31% had DSS. Acute Kidney Injury and Predictors The prevalence of AKI in our cohort was 5.79%, comparable to studies by Mehra et al. (2012) and Khalil et al. (2012) but lower than studies from Malaysia and India reporting rates as high as 15.8%. The variation may be attributed to differences in study design, diagnostic criteria, and population characteristics. Several factors were significantly associated with AKI: Male gender (7.18% vs. 1.53%, p=0.016), aligning with previous findings by Khalil et al. (2012) and Mallhi et al. (2015). Age >60 years had the highest prevalence (52.94%), suggesting older adults are at greater risk, consistent with Lee et al. (2009). Severity of dengue AKI was present in 100% of DSS cases, reinforcing its strong association with severe dengue (p<0.001). Pathophysiologically, AKI in dengue may result from capillary leakage, hypotension, rhabdomyolysis, direct viral nephropathy, or immune-mediated injury. Dengue-associated AKI is often pre-renal due to plasma leakage and shock, as highlighted by Hommel et al. Management, Complications, and Outcomes Platelet transfusion was required in 48.97% of patients, correlating with significant thrombocytopenia. Other complications included serositis (49.53%), hepatitis (1.5%), and MODS (0.93%). Despite these complications, the majority (99.07%) recovered, with a low mortality rate of 0.93%. Table 11. Association of AKI with serum creatinine at admission. AKI Serum creatinine (mg/dL) Absent Present Total No. % No. % No. % < 0.7 95 97.94 2 2.06 97 100.00 0.7 to 1.20 56 70.89 23 29.11 79 100.00 > 1.20 353 98.33 6 1.67 359 100.00 Total 504 94.21 31 5.79 535 100.00 p < 0.001 In the present study significant association was found between serum creatinine at admission and AKI (p<0.001). Table 12. Association of AKI with platelet count at admission. AKI Platelet count (x 103 /cumm) Absent Present Total No. % No. % No. % <20 121 90.98 12 9.02 133 100.00 20 to 49 173 97.74 4 2.26 177 100.00 50 to 99 108 90.76 11 9.24 119 100.00 100 to 150 68 97.14 2 2.86 70 100.00 >150 34 94.44 2 5.56 36 100.00 Total 504 94.21 31 5.79 535 100.00 Page - 6Open Access, Volume 10 , 2025

Dr. Akashdeep Singh Directive Publications p = 0.026 In the present study 9.02% of the patients with platelet count < 20,000 /cumm developed AKI compared to other counterparts (p=0.026). Table 13. Association of AKI with blood urea at admission. AKI Blood urea (mg/dL) Absent Present Total No. % No. % No. % <17 163 99.39 1 0.61 164 100.00 17 to 49 15 45.45 18 54.55 33 100.00 > 49 326 96.45 12 3.55 338 100.00 Total 504 94.21 31 5.79 535 100.00 p < 0.001 In this study positive association was found between AKI and blood urea at admission (p<0.001). Table 14. Association of AKI with serositis. AKI Serositis Absent Present Total No. % No. % No. % Present 245 92.45 20 7.55 265 100.00 Absent 259 95.93 11 4.07 270 100.00 Total 504 94.21 31 5.79 535 100.00 p = 0.097 In the present study no association was found between serositis and AKI (p=0.097). Table 15. Association of AKI with hypotension. AKI Hypotension Absent Present Total No. % No. % No. % Present 5 71.43 2 28.57 7 100.00 Absent 499 94.51 29 5.49 528 100.00 Total 504 94.21 31 5.79 535 100.00 p < 0.001 In this study significantly higher of patients with hypotension (28.57% vs 5.49% developed AKI (p<0.001). Table 16. Association of AKI with mortality. AKI Mortality Absent Present Total No. % No. % No. % Survivor 504 95.09 26 4.91 530 100.00 Non survivor 0 0.00 5 100.00 5 100.00 Total 504 94.21 31 5.79 535 100.00 p < 0.001 In this study significantly higher mortality was noted in patients with AKI (100% vs 0%; p<0.001). Page - 7Open Access, Volume 10 , 2025

Dr. Akashdeep Singh Directive Publications Table 17. Comparison of clinical and laboratory characteristics in patients with and without AKI. AKI Variables Present (=31) Absent (n=504) p value Mean SD Mean SD Age (Years) 45.20 17.63 30.69 11.63 <0.001 PR (bpm) 97.07 18.45 86.01 13.64 0.004 Systolic BP (mm Hg) 109.50 16.50 111.92 10.99 0.449 Diastolic BP (mm Hg) 73.79 11.92 77.03 7.31 0.165 RR (/minute) 23.13 6.72 18.18 2.17 <0.001 Temperature (0C) 96.46 11.06 99.12 0.93 0.198 Hb (mg/dL) 13.72 3.17 14.58 2.10 0.160 PCV (%) 39.97 7.33 42.05 6.10 0.137 Total count cells (/cumm) 9480.00 6545.09 5855.74 4613.55 0.005 Neutrophil (%) 68.93 17.35 55.11 17.27 <0.001 Lymphocyte (%) 24.93 16.11 35.55 17.22 0.001 Monocyte (%) 5.20 3.10 7.19 3.07 0.002 Eosinophils (%) 2.33 4.04 5.33 5.35 0.331 Platelet count on day 1 (x103) 58.17 51.54 59.41 54.12 0.901 PT/INR (sec) 1.39 0.59 1.11 0.29 0.018 aPTT (sec) 1.53 0.48 1.30 0.41 0.032 Blood urea (mg/dL) 60.33 34.18 22.54 10.88 <0.001 Serum creatinine Day 1 (mg/dL) 2.15 1.20 0.90 0.27 <0.001 Sodium (mmol/L) 135.63 4.44 135.99 4.18 0.672 Potassium (mmol/L) 4.39 0.93 4.25 0.53 0.423 Bicarbonate (mmol/L) 18.93 4.13 21.84 3.39 0.001 Total bilirubin (mg/dL) 3.00 3.03 0.88 0.97 0.001 Direct biliruibin (mg/dL) 2.32 2.66 0.49 0.80 0.001 SGOT (IU/L) 1053.53 2138.23 211.78 383.76 0.040 SGPT (IU/L) 440.17 796.96 123.00 198.75 0.038 Serum albumin (mg/dL) 3.16 0.50 3.71 0.48 <0.001 Alkaline phosphatase (mg/dL) 208.50 234.24 107.45 87.22 0.025 RBS (mg/dL) 130.20 61.34 127.24 56.11 0.798 Hospital stay (Days) 6.60 5.65 5.60 2.32 0.341 In the present study significant association was found between serum creatinine at admission and AKI (p<0.001). In the present study 9.02% of the patients with platelet count < 20,000 /cumm developed AKI compared to other counterparts (p=0.026). In this study positive association was found between AKI and blood urea at admission (p<0.001). In the present study no association was found between serositis and AKI (p=0.097). In this study significantly higher of patients with hypotension (28.57% vs 5.49% developed AKI (p<0.001). In this study significantly higher mortality was noted in patients with AKI (100% vs 0%; p<0.001). In the present study significant differences were noted in patients with and without AKI pertaining to age (45.20±17.63 vs 30.69±11.63 years; p<0.001), pulse rate (97.07±18.45 vs 86.01±13.64 per minute; p=0.004), respiratory rate (23.13±6.72 vs 18.18±2.17 per minute; p<0.001), total count (9480.00±6545.09 vs 5855.74±4613.55 per cumm; p=0.005), neutrophils Page - 8Open Access, Volume 10 , 2025

Dr. Akashdeep Singh Directive Publications (68.93±17.35 vs 55.11±17.27 percent; p<0.001), lymphocyte (24.93±16.11 vs 35.55±17.22 percent; p=0.001), monocyte (5.20±3.10 vs 7.19±3.07 percent; p=0.002), International normalized ratio (1.39±0.59 vs 1.11±0.29; p=0.018), aPTT (1.53±0.48 vs 1.30±0.41; p=0.032), blood urea (60.33±34.18 vs 22.54±10.88 mg/dL; p<0.001), Serum creatinine on day one (2.15± 1.20 vs 0.90±0.27 mg/dL; p<0.001), bicarbonate (18.93±4.13 vs 21.84±3.39 mmol/L; p=0.001), total bilirubin (3.00±3.03 vs 0.88±0.97 mg/dL; p=0.001), direct bilirubin (2.32± 2.66 vs 0.49±0.80 mg/dL; p=0.001), SGOT (1053.53±2138.23 vs 211.78±383.76 IU/L; p=0.040), SGPT (440.17±796.96 vs 123.00±198.75 IU/L; p=0.038), serum albumin (3.16±0.5 vs 3.71±0.47 mg/dL; p<0.001) and alkaline phosphatase (208.50±234.24 vs 107.45±87.22mg/dL; p=0.025). CONCLUSION Based on the findings of this study it may be concluded that, there is high prevalence of AKI (5.79%) in patients presenting with dengue fever in the study area hence it cannot be neglected. The significant predictors of AKI in patients with DF are male gender, advanced age, Hypotension, high serum creatinine and blood urea levels at the time of admission and lower platelet count at admission., evidence of polyserositis, other complications. Laboratory parameters including raised total count, International normalized ratio, a PTT, abnormal liver function tests at admission are also associated with risk developing AKI in patients with DF. Persons with DHF and DSS had more evidence of AKI compared to Dengue fever. The person who developed AKI had a more mortality. SUMMARY Renal complications in dengue fever remain an underexplored aspect, with manifestations ranging from mild urinary abnormalities to severe acute kidney injury (AKI). This study aimed to evaluate the prevalence of AKI in dengue fever and identify predictors for its development. A one-year hospital-based cross-sectional study was conducted at the Department of General Medicine, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, from January to December 2017. Of the 610 adult patients who tested positive for dengue NS1/IgM, 535 met the inclusion criteria. AKI was diagnosed using AKIN criteria, and potential risk factors were analyzed. Key findings include • The majority of patients were male (75.51%), with a male-to-female ratio of 3.08:1. The mean age was 31.52 ± 12.47 years. • Fever was a universal symptom (100%), followed by myalgia (69.91%), vomiting (67.66%), and nausea (66.92%). Skin manifestations included rashes (31.79%) and petechial hemorrhages (25.23%). • Laboratory findings revealed elevated SGOT (92.34%) and SGPT (82.06%). Proteinuria was observed in 21.31% of patients, while hematuria was rare (0.56%). • Radiological findings showed thickened gallbladder (40.19%), ascites (47.66%), and splenomegaly (6.36%). • Platelet transfusion was required in 48.97% of cases. • Disease severity distribution: dengue fever (82.99%), dengue hemorrhagic fever (15.7%), and dengue shock syndrome (1.31%). • AKI prevalence was 5.79%, with a significantly higher occurrence in males (7.18% vs. 1.53%, p=0.016) and older age groups (p<0.001). AKI was diagnosed in all patients with DSS (100%) compared to DHF (4.76%) and DF (4.5%) (p<0.001). • Hypotension (28.57% vs. 5.49%, p<0.001) and complications like MODS or encephalitis (46.67% vs. 4.62%, p<0.001) were strongly associated with AKI. • Significant predictors of AKI included elevated blood urea, serum creatinine, INR, aPTT, total and direct bilirubin, SGOT, SGPT, and alkaline phosphatase levels (p<0.001). • Mortality was observed in five patients (0.93%), all of whom had AKI (p<0.001). This study highlights a significant prevalence of AKI (5.79%) among dengue patients, emphasizing the need for early identification and management of renal involvement in dengue fever. REFERENCES 1. Rice CM. Flaviviridae: The viruses and their replication. In: Virology Fields BN, Knipe DM, Howley PM eds. 3rd ed., Philadelphia: Lippincott-Raven Publishers, 1996. p. 931-59. 2. WHO. Scientific Working Group Report on Dengue [online]. Geneva, Switzerland: WHO; 2007. 3. TDR/WHO. Evaluation of commercially available anti- dengue virus immunoglobulin M tests. Diagnostics Evaluation Series No.3 Geneva. Switzerland: TDR/WHO; 2009. 4. Guzman MG, Kouri G. Dengue: an update. Lancet Infect Dis 2002; 2:33-42. 5. Gubler DJ. The changing epidemiology of yellow fever and dengue, 1900 to 2003: full circle? Comp Immunol Microbiol Infect Dis 2004;27:319–30. Page - 9Open Access, Volume 10 , 2025

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Dr. Akashdeep Singh Directive Publications 82. Boonpucknavig V, Bhamarapravati N, Boonpucknavig S, Futrakul P, Tanpaichitr P. Glomerular changes in dengue hemorrhagic fever. Arch Pathol Lab Med 1976;100:206-12. 83. Jessie K, Fong MY, Devi S, Lam SK, Wong KT. Localization of dengue virus in naturally infected human tissues, by immunohistochemistry and in situ hybridization. J Infect Dis 2004;189:1411-8. 84. Basílio-de-Oliveira CA, Aguiar GR, Baldanza MS, Barth OM, Eyer-Silva WA, Paes MV. Pathologic study of a fatal case of dengue-3 virus infection in Rio de Janeiro, Brazil. Braz J Infect Dis 2005;9:341-7. 85. Mohsin N, Mohamed E, Gaber M, Obaidani I, Budruddin M, Al Busaidy S. Acute tubular necrosis associated with non-hemorrhagic dengue fever: a case report. Renal Fail 2009;31:736-9. 86. Repizo LP, Malheiros DM, Yu L, Barros RT, Burdmann EA. Biopsy proven acute tubular necrosis due to rhabdomyolysis in a dengue fever patient: a case report and review of literature. Rev Inst Med Trop Sao Paulo 2014;56:85-8. 87. Nath P, Agrawal DK, Mehrotra RM. Ultrastructural changes in skeletal muscles in dengue virus-infected mice. J Pathol 1982;136:301-5. 88. Gandini M, Reis SR, Torrentes-Carvalho A, Azeredo EL, Freire Mda S, Galler R, et al. Dengue-2 and yellow fever 17DD viruses infect human dendritic cells, resulting in an induction of activation markers, cytokines and chemokines and secretion of different TNF-α and IFN-α profiles. Mem Inst Oswaldo Cruz 2011;106:594-605. 89. Malheiros SM, Oliveira AS, Schmidt B, Lima JG, Gabbai AA. Dengue. Muscle biopsy findings in 15 patients. Arq Neuropsiquiatr 1993;51:159-64 90. Bosch X, Poch E, Grau JM. Rhabdomyolysis and acute kidney injury. N Engl J Med 2009;361:62-72. 91. Davis JS, Bourke P. Rhabdomyolysis associated with dengue virus infection. Clin Infect Dis 2004;38:e109-11. 92. Finsterer J, Kongchan K. Severe, persisting, steroid- responsive dengue myositis. J Clin Virol 2006;35:426-8. 93. Lim M, Goh HK. Rhabdomyolysis following dengue virus infection. Singapore Med J 2005;46:645-6. 94. Upadhaya BK, Sharma A, Khaira A, Dinda AK, Agarwal SK, Tiwari SC. et al. Transient IgA nephropathy with acute kidney injury in a patient with dengue fever. Saudi J Kidney Dis Transpl 2010;21:521-5. 95. Bhagat M, Zaki SA, Sharma S, Manglani MV. Acute glomerulonephritis in dengue haemorrhagic fever in the absence of shock, sepsis, haemolysis or rhabdomyolysis. Paediatr Int Child Health 2012;32:161-3. 96. Lizarraga KJ, Florindez JA, Daftarian P, Andrews DM, Ortega LM, Mendoza JM, et al. Anti-GBM disease and ANCA during dengue infection. Clin Nephrol 2015;83:104-10. 97. Wills BA, Nguyen MD, Ha TL, Dong TH, Tam MD, Tran TN, et al. Comparison of three fluid solutions for resuscitation in dengue shock syndrome. N Engl J Med 2005; 353: 877-89. 98. Zhang F, Kramer CV. Corticosteroids for dengue infection. Cochrane Database Syst Rev 2014;7:CD003488. 99. Mehta RL, Cerdá J, Burdmann EA, Tonelli M, García- García G, Jha V, et al. International Society of Nephrology’s 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet 2015;385:2616-43 100. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31. 101. Daher Ede F, Junior Silva GB, Vieira AP, Souza JB, Falcão Fdos S, Costa CR, et al. Acute kidney injury in a tropical country: a cohort study of 253 patients in an infectious diseases intensive care unit. Rev Soc Bras Med Trop 2014;47:86-9. 102. Basu G, Chrispal A, Boorugu H, Gopinath KG, Chandy S, Prakash JA, et al. Acute kidney injury in tropical acute febrile illness in a tertiary care centre–RIFLE criteria validation. Nephrol Dial Transplant 2011; 26: 524–531. 103. Khalil MA, Tan J, Khalil MA, Awan S, Rangasami M. Predictors of hospital stay and mortality in dengue virus infection-experience from Aga Khan University Hospital Pakistan. BMC Res Notes 2014;7:473. 104. Kuo MC, Lu PL, Chang JM, Lin MY, Tsai JJ, Chen YH, et al. Impact of renal failure on the outcome of dengue viral Page - 14Open Access, Volume 10 , 2025

Dr. Akashdeep Singh Directive Publications infection. Clin J Am Soc Nephrol 2008;3:1350-6. 105. Mallhi TH, Khan AH, Adnan AS, Sarriff A, Khan YH, Jummaat F. Incidence, Characteristics and Risk Factors of Acute Kidney Injury among Dengue Patients: A Retrospective Analysis. PLoS One. 2015; 10(9):e0138465. 106. WHO. Dengue haemorrhagic fever: diagnosis, treatment, prevention and control, 2nd ed. Geneva, World Health Organization, 1997. 107. Agarwal J, Kapoor G, Srivastava S, Singh KP, Kumar R, Jain A. Unusual clinical profile of Dengue Infection in patients attending a tertiary care teaching hospital in north India. Int J Infect Dis 2010;14:174-5. 108. Chakravarti A, Matlani M, Kashyap B, Kumar A. Awareness of changing trends in epidemiology of dengue fever is essential for epidemiological surveillance. Indian J Med Microbiol 2012;30(2):222-6. 109. Navarrete-Espinosa J, Gomez-Dantes H, Celis-Quintal JG, Vazquez-Martinez JL. Clinical profile of dengue hemorrhagic fever cases in Mexico. Salud Publica Mex 2005;47:193-200. 110. Narayanan M, Aravind MA, Thilothammal N, Prema R, Sargunam CS, Ramamurty N. Dengue Fever Epidemic In Chennai:A Study Of The Clinical Profile And Outcome. Indian Paediatr 2002;39:1027-33. 111. Padbidri VS, Adhikari P, Thakare JP, Ilkal MA, Joshi GD, Pereira P, et al. The 1993 epidemic of dengue fever in Mangalore, Karnataka state, India. South East Asain J Trop Med Public Health 1995;26(4):699-704. 112. Tripathi BK, Gupta B, Sinha RSK, Prasad S, Sharma DK. Experience in adult population in Dengue outbreak in Delhi. JAPI 1998;46:273-6. 113. Hommel D, Talarmin A, Reynes JM, Hulin A. Acute renal failure associated with dengue fever in French Guiana. Nephron 1999;83(2):183. 114. Vakrani GP, Subramanya MNT. Acute Renal Failure in Dengue Infection. J Clin Diagnostic Res 2017;11(1):OC10- 1310. 115. Naqvi R. Dengue Infection Causing Acute Kidney Injury. Trop Med Surg 2016;4(2):1-4. 116. Lee K, Liu JW, Yang KD. Clinical and laboratory characteristics and risk factors for fatality in elderly patients with dengue hemorrhagic fever. Am J Trop Med Hyg 2008;79:149-53.

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