Acute Kidney Injury Affects One in Four Patients With Scrub Typhus: Study

Scrub typhus (Orientia tsutsugamushi) often presents non-specifically, frequently masking underlying acute kidney injury (AKI). To address this critical regional data gap, Karur and colleagues from Sri Devaraj Urs Medical College, India, investigated the prevalence, clinical characteristics, and independent predictors of AKI in adult scrub typhus patients.

Therefore, the retrospective study evaluated 176 adults with rickettsial infections at a Karnataka tertiary hospital between 2021 and 2024. To precisely determine AKI prevalence, systemic complications, and intensive care needs, patients with concurrent tropical co-infections were deliberately excluded, and logistic regression was utilized to clinically compare the profiles of those with and without AKI.

Key Clinical Findings of the Study Includes:

• Disease Prevalence: Researchers found that exactly 25% of the study cohort (44 out of 176 patients) developed AKI, categorized into Stage 1 (15.3%), Stage 2 (4.5%), and Stage 3 (5.1%) according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria, with only 4% ultimately requiring dialysis.

• Independent Predictors: Investigators noted that being over 50 years of age (odds ratio [OR] 3.60), male gender (OR 4.14), and having pre-existing diabetes mellitus (OR 3.13) significantly and independently increased the risk of developing severe renal complications compared to patients without AKI.

• Systemic Complications: Scientists observed a profound association between acute renal decline and critical disease progression, evidenced by a 5.42-fold increased likelihood of septic shock and a striking 52.8-fold increased risk for multi-organ dysfunction syndrome (MODS).

• Laboratory Abnormalities: Clinicians reported that patients experiencing AKI presented with significantly lower serum albumin levels (2.47 versus 2.84 g/dL) and reduced platelet counts (97.06 versus 145.94 ×10³/mL), alongside markedly elevated total bilirubin (4.40 versus 1.85 mg/dL) compared to the unaffected group.

The results suggest that acute kidney injury affects 25% of individuals battling scrub typhus and contributes to a 2.8% overall mortality rate, predominantly impacting older males grappling with existing comorbidities. Fortunately, this alarming renal complication is frequently reversible when aggressive supportive therapy and proper critical care are initiated early in the disease course.

Thus, the study concludes healthcare providers should maintain a heightened clinical suspicion for renal involvement when treating febrile illnesses in endemic regions, as timely intervention and the appropriate administration of antibiotics can positively alter the disease trajectory and reduce potentially fatal complications.

Because the study was fundamentally a retrospective single-center evaluation, the specific findings may not be universally applicable across all populations, indicating a modest need for larger, multicenter prospective investigations to further illuminate the nuanced complexities of scrub typhus-associated kidney injury.

Reference

Karur AK, Inba P, Rao SN. Acute Kidney Injury Due to Rickettsial Infection - Data from a Tertiary Care Center in Southern India. IJN. Published April 25, 2026.