Kidney involvement in malaria: an update

Abstract

Malaria is an infectious disease of great importance for Public Health, as it is the most prevalent endemic disease in the world, affecting millions of people living in tropical areas of the globe. Kidney involvement is relatively frequent in infections by P. falciparum and P. malariae, but has also been described in the infection by P. vivax. Kidney complications in malaria mainly occur due to hemodynamic dysfunction and immune response. Liver complications leading to hepatomegaly, jaundice and hepatic dysfunction can also contribute to the occurrence of acute kidney injury. Histologic studies in malaria also evidence glomerulonephritis, acute tubular necrosis and acute interstitial nephritis. It is also possible to find chronic kidney disease associated with malaria, mainly in those patients suffering from repeated episodes of infection. Plasmodium antigens have already been detected in the glomeruli, suggesting a direct effect of the parasite in the kidney, which can trigger an inflammatory process leading to different types of glomerulonephritis. Clinical manifestations of kidney involvement in malaria include proteinuria, microalbuminuria and urinary casts, reported in 20 to 50% of cases. Nephrotic syndrome has also been described in the infection by P. falciparum, but it is rare. This paper highlights the main aspects of kidney involvement in malaria and important findings of the most recent research addressing this issue.

Renal Localization of Plasmodium vivax and Zoonotic Monkey Parasite Plasmodium knowlesi in Malaria Associated Acute Kidney Injury

“…Hemozoin pigment is known to be produced only by replicating parasites [16]. When in circulation, it is rapidly phagocytosed by macrophages and dendritic cells and therefore, has a short circulating half life [17,18] Hemozoin pigment in renal tissue has been demonstrated in the case of P. falciparum associated AKI [9]. Therefore, presence of hemozoin staining specifically in renal tubules and interstitiumis suggestive of the presence of replicating parasites at the site, rather than non specific accumulation of hemozoin.…”

“…Acute kidney injury (AKI), is a frequently presentation in severe malaria due to both P. falciparum and P. vivax, and more recently has also been shown to be associated with P. knowlesi [5][6][7][8]. In fact, overall AKI has been shown to have a global prevalence in about 20-50% hospitalized malaria cases [9]. Pathogenesis of P. falciparum is attributed to its cytoadherence to endothelial cells of tissue capillaries.…”

Kidney Histopathological Observations on Plasmodium Vinckeivinkei Infection in Protein-Malnourished Mice

“…The swelling of the glomeruli and the increased thickness of the basement membrane have been described in other studies (7)(8)(9)(10) and attributed to the deposition of the malarial immune complexes (antigen, antibody and complement) (12,13) . It has been reported that the immune complex can be formed and localized in the glomeruli during human malaria (12)(13)(14)(15) resulting in the nephrotic syndrome (1,2) . The new and interesting observation as regards the pathological lesions in the kidneys is the evidence for degeneration of the proximal convoluted tubules (tubular nephrosis)…”

“…The usual consequences of malarial infection are tropical hepatosplenomegaly and nephrotic syndrome (1,2) .…”

Renal detection of Plasmodium falciparum, Plasmodium vivax and Plasmodium knowlesi in malaria associated acute kidney injury: a retrospective case–control study

“…Acute kidney injury (AKI), is a frequent presentation in severe malaria which is associated with mortality [1][2][3][4][5]. Overall, AKI has been shown to have a global prevalence in about 20-50% hospitalized malaria cases [6,7]. While P. falciparum is found all over the tropical world, P. vivax is highly prevalent in South America, India and South East (S. E.) Asia, and P. knowlesi has been shown to cause malaria predominantly in S.E.…”