Acute Kidney Injury during Malaria in Togolese Children

Abstract

Objective: To describe clinical, biological and evolutionary profile of Acute Kidney Injury (AKI) due to Severe Malaria in the pediatric department. Methodology: This was a retrospective descriptive study that took place from January to December 2012. It has been included children aged 0-15 years admitted for severe malaria with positive thick drop. AKI was defined by using the modified RIFLE (Risk Injury Failure Loss End stage) classification for Pediatrics. Results: 338 children admitted for severe malaria were included. AKI was diagnosed in 24 children, a prevalence of 7.1% according to pRIFLE classification: RISK in 10 (3%), INJURY in 9 (2.6%) and FAILURE in 5 (1.5%). The average age was 8.16 ± 4.2 years. Clinical features were dominated by hemoglobinuria in 87.5%, oliguria, vomiting and fever in 75%. The biological features were dominated by severe anemia (Hb < 6 g/dl) in 79.2% of cases. Hyperkalemia (K > 5.5 mmol/l) was found in 2 cases. The mean parasitic density was 22,120 trophozoites. Malaria was treated primarily with artemether in 83.3% of the cases. Dialysis was indicated in 2 cases for menacing hyperkalaemia, but was not done because of lack of financial means. In one case, hyperkalaemia was successfully treated with symptomatic measures, but in the second case, these measures were not allowed to normalize kalaemia, and death occurred. Conclusion: Acute post-malarial renal failure secondary to tubular necrosis may be the dominant clinical features of severe malaria. Death may occur. Preventing malaria would be the best way to avoid it.

Factors Associated with Acute Kidney Injury among Children with Severe Malaria at Kiryandongo General Hospital, Uganda

“…Children aged less than 5 years were 1.8 times more likely to develop AKI compared to those aged 5 years and more (Table 2). Similarly Oshoma et al [17] in Nigeria found that the [6] in Uganda found a median age of 3.2 years. This can be explained by the fact that children less than 2 years were shown having a high risk of developing AKI in high transmission area of malaria [6].…”

“…Children aged less than 5 years were 1.8 times more likely to develop AKI compared to those aged 5 years and more ( Table 2 ). Similarly Oshoma et al [ 17 ] in Nigeria found that the median age of children with severe malaria associated to AKI was 3.5 years. Conroy et al [ 6 ] in Uganda found a median age of 3.2 years.…”

“…Similarly, Batte et al [ 18 ] found that severe anemia was associated with AKI (79.2%). Sabi et al [ 17 ] in India found that 83.3% of children with severe malaria-associated AKI had anemia. Studies have reported that parasite sequestration, hemolysis, and endogenous nephrotoxic (malaria pigment) are frequent etiological factors of severe malaria-associated AKI [ 20 ].…”