Acute kidney injury in imported Plasmodium falciparum malaria

Abstract

BackgroundAcute kidney injury (AKI) is a known complication of malaria, and is reported to occur in up to 40 % of adult patients with a severe Plasmodium falciparum infection in endemic regions. To gain insight in the incidence and risk factors of AKI in imported P. falciparum malaria, a retrospective analysis was performed on a large cohort of mostly non-immune patients with imported P. falciparum malaria. Aiming to include not only severe but also milder forms of renal failure, the KDIGO criteria were used to define AKI.MethodsClinical and laboratory data from 485 consecutive cases of imported P. falciparum malaria were extracted from the Rotterdam Malaria Cohort database. Acute kidney injury (AKI) was defined using the KDIGO criteria. Univariate and multivariate logistic regression analyses were used to identify risk factors for AKI.ResultsAKI was seen in 39 (8 %) of all patients and in 23 (38 %) of the 61 patients with severe malaria. Eight patients eventually needed renal replacement therapy (RRT); seven of them already had AKI at presentation. Higher age, higher leucocyte count and thrombocytopaenia were independently-associated with AKI but their positive predictive values were relatively poor.ConclusionAKI was found to be a common complication in adults with imported P. falciparum necessitating RRT in only a small minority of patients. The use of the KDIGO staging allows early recognition of a decline in renal function.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-1057-9) contains supplementary material, which is available to authorized users.

Acute Kidney Injury in Western Countries

“…Following P. falciparum infection, AKI will occur in 1-4% of patients but may occur in up to 60% depending on the region [2]. Risk factors for AKI are not well characterized [23,24]. Prompt initiation of antimalarial drugs, surveillance of kidney function, and initiation of dialysis if required can contribute to improve survival and facilitate renal recovery [23].…”

Novel kidney injury biomarkers in tropical infections: a review of the literature

“…AKI in malaria is more frequent in infections caused by Plasmodium falciparum, and manifestations include oliguria, severe metabolic acidosis, hypercatabolic state and hydroelectrolytic disorders, such as hyponatremia and hyperkalemia 39 . The histopathological findings in malariaassociated AKI include acute tubular necrosis, interstitial nephritis, inflammatory interstitial infiltrate, edema and glomerulonephritis, and the pathogenesis is associated to blockade of renal microcirculation, hemodynamic factors and hypovolemia [40][41][42] .…”

Acute kidney injury in Plasmodium vivax malaria hospitalized patients in Manaus, Brazilian Amazon: are we underestimating the real burden?

“…Kidney involvement is relatively frequent in malaria caused by P. falciparum and P. malariae infections, being routinely associated to increased mortality and morbidity [6,7]. This condition may affect up to 40% of complicated cases of falciparum malaria, with mortality reaching 75% in some areas [8][9][10]. Hemodynamic dysfunction and immune response seem to play an important role in its pathogenesis [11].…”