Acute kidney injury in patients with Plasmodium vivax malaria: Clinicohistopathological profile

Kimmatkar, Piyush; Jhorawat, Rajesh; Gandhi, Kunal; Kumar, Rajesh; Malhotra, Vinay; Agrawal, D. P.; Beniwal, Pankaj

doi:10.4103/2278-0521.195819

Cited by 3 publications

(1 citation statement)

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“…Overall, of 16 malaria cases presenting with AKI, 14 (~88%) had P. vivax, 7 had P. knowlesi and 5 had P. falciparum infection as mono-infections as well as mixed-infections. Although several studies show association of AKI with peripheral blood P. vivax and P. knowlesi infection [5,6,[13][14][15] we demonstrate direct tissue presence of the parasite derived DNA for both these species. Interestingly, of the 16 cases, 9 had no evidence of the parasite from microscopic examination of peripheral blood smears, suggesting that microscopic examination alone may not be sufficient for detection and diagnosis of P. vivax and P. knowlesi.…”

Section: Discussioncontrasting

confidence: 61%

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

Acharya

Pramanik

Kaur

et al. 2019

Preprint

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ObjectivesAcute kidney injury (AKI) is a frequent clinical manifestation of severe malaria. Although the pathogenesis of P. falciparum severity is attributed to cytoadherence, the pathogenesis due to P. vivax and P. knowlesi are not very well understood and their presence within the host tissue has not been demonstrated. Therefore, the objective of this study was to determine if P. vivax and P.knowlesi interact with host renal tissue in malarial AKI. MethodsArchival FFPE renal biopsies from 16 patients having AKI with suspected or confirmed malaria diagnosis, and 5 patients with non-malarial AKI, were subjected to histopathological analysis and DNA extraction. The total DNA from these renal biopsies was used to investigate the presence of the 5 species of human malaria parasite: P. falciparum, P. vivax, P. knowlesi, P.malariae and, P. ovale. The results of histopathology and PCR analysis were analyzed to understand the pathogenesis of malaria associated AKI. ResultsRenal biopsies from malarial AKI patients were found to harbor DNA from P. vivax (14 of 16), the zoonotic monkey parasite P. knowlesi (7) and P. falciparum (5) in the form of monoinfections as well as mixed infections. Sanger sequencing was used to confirm species identity.Histopathological analysis revealed the presence of microvascular injury as a common feature of P. vivax and P. knowlesi related AKI. Hemozoin could be detected within the renal tissue, which indicated the presence of metabolically active parasites. ConclusionsP. vivax and P. knowlesi associated AKI may involve interaction of the host renal tissue with parasite derived components such as Plasmodium DNA and hemozoin which may lead to innate immune activation and host tissue injury.

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Section: Discussioncontrasting

confidence: 61%

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

Acharya

Pramanik

Kaur

et al. 2019

Preprint

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

et al. 2020

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Objective: Acute kidney injury (AKI) is a frequent presentation in malaria infections. Several cases of AKI that are accompanied by clinical symptoms of malaria infection, such as fever, nausea, respiratory distress, and anemia remain undiagnosed due to challenges in accurate diagnosis using peripheral blood microscopy and rapid diagnostic tests that are currently used in clinical settings. This is particularly true for P. vivax and P. knowlesi infections. As a result, these patients are not able to receive anti-malarial therapy in a timely manner. The objective of the present study was to investigate if patients presenting with AKI harbored any of the five human Plasmodium species (P. falciparum, P. vivax, P. knowlesi, P. malariae, and P. ovale) within their renal tissues. Results: We found that renal biopsies from malaria associated AKI patients harbor the human malaria parasites P. falciparum, P. vivax and P. knowlesi as mono-and mixed species infections. Presence of microvascular injury in a majority of the malaria associated AKI cases suggested vascular involvement of P. vivax and P. knowlesi. This research note also highlights P. knowlesi as an emerging pathogen in the Indian subcontinent.

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Clinical Profile and Treatment Outcomes of Patients with Malaria Complicated by Acute Kidney Injury

Naik,

Acharya,

Rout

2023

Saudi Journal of Kidney Diseases and Transplantation

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As Odisha is an endemic region for malaria with many acute kidney injury (AKI) cases, this study evaluated the clinical profile and treatment outcomes of patients with malaria complicated by AKI. This prospective observational study was conducted between December 2015 and September 2017. Detailed histories and clinical examinations were recorded. On admission, tests for routine hematology, plasma glucose, liver function, renal function, serum electrolytes, thick smears, thin smears, and malarial parasites were performed. Of the 958 AKI malarial patients admitted, 202 (82.6 % males) were included in the study, with a mean age of 38.37 years. In total, 86.14%, 3.46%, and 10.39% of patients had Plasmodium falciparum, Plasmodium vivax, and mixed malaria, respectively. Headache and decreased urination (83.66% each) were the most common symptoms after fever (100%). Anuria and oliguria were reported in 5.95% and 67.82% of patients, respectively, whereas 26.23% reported a urine output of >400 mL/24 h. All patients had raised serum creatinine and urea levels, and >60% had anemia, proteinuria, and/or hyponatremia. Multiple organ dysfunction syndrome was observed in 62.87% of patients. Acute tubular necrosis was seen in 60% of renal biopsy specimens (n = 15). Of the 75.75% of patients requiring dialysis, 82.12% and 17.88% of patients required hemodialysis and peritoneal dialysis, respectively, during which 11 patients died. AKI, a serious complication of P. falciparum or P. vivax malaria, is a life-threatening condition. Fever, anemia, oligo/anuria, hepatic involvement, cerebral malaria, high serum creatinine and urea, and disseminated intravascular coagulation were the main predictors of mortality in our study.

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Acute kidney injury in patients with Plasmodium vivax malaria: Clinicohistopathological profile

Cited by 3 publications

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

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

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

Clinical Profile and Treatment Outcomes of Patients with Malaria Complicated by Acute Kidney Injury

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