Acute Renal Failure from Myoglobinuria Secondary to Myositis from Severe Falciparum Malaria

Abstract

Renal disease is a common complication in malaria infection. In acute falciparum malaria renal involvement is usually mild, but in severe disease acute renal failure is a major problem. Acute renal failure has been attributed to ischaemic tubular necrosis from hypovolaemia resulting from vasodilatation due to endothelial injury. Though myositis is recorded as a common manifestation in falciparum malaria, only 1 case with myositis and myoglobinuria with acute renal failure has been documented; but no renal biopsy was performed in the patient. In the present study we examined the case of a 17-year-old man with severe falciparum malaria with myositis and myoglobinuria who developed acute renal failure requiring dialysis. Muscle biopsy revealed severe myositis with macrophages and T lymphocytes including CD4+ cells. The kidney biopsy showed scanty T cells and macrophages in the glomeruli which were only mildly hypercellular. The renal tubules showed myoglobin casts in the lumen and foci of interstitial inflammatory cells, including macrophages and T lymphocytes but no CD4+ cells. Rhabdomyolysis induced by macrophages and T cells with myoglobinuria and acute renal failure is a problem in severe falciparum malaria infection.

Specific Macrophage Subtypes Influence the Progression of Rhabdomyolysis-Induced Kidney Injury

“…1,30 The potential clinical relevance of the present work stems from the similarities between the macrophage infiltrate observed in our patient and a reported patient with infection-induced rhabdomyolysis. 8 In a rat model, macrophages, defined according to F4/80 detection, have been observed 2 days after rhabdomyolysis; 7 a + distribution in the three regions. n=3-6.…”

“…5 It is now acknowledged that inflammation plays a major role in the development of ischemic AKI, 6 but the possibility that rhabdomyolysisinduced AKI could be an inflammatory disease has not yet been proposed. While macrophage infiltration has been reported in a rat glycerol-induced AKI model 7 and in a kidney biopsy specimen from a patient with rhabdomyolysis, 8 the role or phenotype of the macrophages remains to be determined in rhabdomyolysisinduced AKI. Macrophages have long been recognized to be heterogeneous.…”

Bacterial, Fungal, Parasitic, and Viral Myositis

“…(190), Echinococcus spp. (202), Entamoeba histolytica (164), Spirometra mansonoides (sparganosis) (128), Plasmodium falciparum (malaria) (56,149,215), and Onchocerca volvulus (161) ( Table 2). In addition, myositis caused by a new muspiceoid nematode was recently reported from Australia (18,58).…”

“…In addition, biochemical changes and histopathologic evidence of skeletal muscle damage (by muscle enzyme elevations or muscle biopsy results, respectively) have been frequently noted (56,149). Rhabdomyolysis and myoglobinuria with acute renal failure are rare complications of severe P. falciparum infection (215). Rhabdomyolysis due to other Plasmodium spp.…”

Urinalysis as a diagnostic tool in severe malaria

“…La mioglobinuria se ha reportado como causante de la orina oscura (51,89,90) y la lesión renal en la malaria (91)(92)(93)(94)(95)(96). La rabdomiolisis es una condición poco informada en la malaria; se ha descrito tanto en la infección con P. vivax como en la causada por P. falciparum (90,97) y poco se sabe de su patogenia.…”