Acute kidney injury in pediatric patients with malaria: A prospective cross-sectional study in the shai-osudoku district of Ghana

Ephraim, Richard K. D.; Adoba, Prince; Sakyi, Samuel Asamoah; Aporeigah, Josephine; Fondjo, Linda Ahenkorah; Botchway, Felix; Storph, Rebecca Peniel; Toboh, Emmanuel

doi:10.4103/1319-2442.279946

Cited by 3 publications

(5 citation statements)

References 14 publications

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“…This frequency was close to 6.6% established by Moussa Tondi et al (14) in Niger in 2016. . The frequency of AKI in the present study remained higher than that of 2% demonstrated by Ephraim et al (15) in Ghana in 2018, 0.7% by Essola et al (16) in Gabon in 2017, and 0.56% by Lalya et al (7) in Benin in 2012. AKI was selected according to the KDIGO criteria and not only because of increase in serum creatinine.…”

Section: Commentary and Comparison Of The Results Obtained Frequencycontrasting

confidence: 69%

Epidemiological, Clinical, Therapeutic, and Evolutionary Aspects of Acute Kidney Damage during Severe Malaria in Children at the Borgou Departmental Teaching Hospital (Benin)

Ahoui

Noudamadjo

Kpanidja

et al. 2022

jrenhep

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Malaria is an endemic pathology with several complications, including kidney damage. The objective of this work was to study kidney damage during severe malaria in children at the pediatrics department of the Borgou Departmental Teaching Hospital (Borgou DTH), Benin in 2021. This was a longitudinal study carried out over 4 months from June 1, 2021 to September 30, 2021 (with 1 month of recruitment from June 1 to July 1, 2021) at the pediatric department of the Borgou DTH. The study included children aged 1 month–15 years, hospitalized for Plasmodium falciparum malaria with at least one clinical manifestation of malaria severity established by the World Health Organization in 2000 and whose parents had given their informed consent. The damage was established by urinary sedimentation using urine dipstick and urinary cap and serum creatinine. Acute kidney injury (AKI) was intended and classified according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. The dependent variable was the presence of at least one clinical, biological, and functional impairment. Follow-up was regular for up to 3 months. Lost to follow-up were excluded. Predictors of occurrence were identified. Statistical difference was considered significant at P < 0.05. Of the 164 children hospitalized for severe malaria during the study period, 72 had at least one renal impairment, with a frequency of 43.90%. The average age of the children was 44.93 months. On urine dipstick, 76.39% of the patients had hemoglobinuria and 55.56% had albuminuria. Urinary cap revealed 44% granular cylindruria and 32% crystalluria. AKI was detected in 4.54% patients. Recovery was complete in all fol-low-up cases. The predictors of kidney damage were coma ( P = 0.017), jaundice ( P = 0.007), thrombocytopenia ( P = 0.021), and long hospital stay ( P = 0.008). Kidney damage in severe malaria is frequent. Early diagnosis and prompt treatment are fundamentals of rapid and complete recovery of kidney functions.

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Section: Commentary and Comparison Of The Results Obtained Frequencycontrasting

confidence: 69%

Epidemiological, Clinical, Therapeutic, and Evolutionary Aspects of Acute Kidney Damage during Severe Malaria in Children at the Borgou Departmental Teaching Hospital (Benin)

Ahoui

Noudamadjo

Kpanidja

et al. 2022

jrenhep

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“…As most AKI in LMIC is community-acquired and present at hospital admission, using the admission creatinine will lead to vast underestimation of AKI. A recent study in Ghana using the admission creatinine as baseline noted an AKI frequency of 2% 27 compared to 32–59% using population approaches. 13–16 A study in Ugandan children with serial creatinine measurements over the first four days of hospitalization estimated 79% of AKI cases were present on admission.…”

Section: Methodological Considerations When Defining Aki In Children With Severe Malariamentioning

confidence: 99%

“…Using KDIGOcompatible guidelines with appropriate estimates of baseline creatinine, the incidence of AKI in severe malaria ranges between 24-59% [13][14][15][16][17] while using non-standard approaches it ranges from 0-33%. [23][24][25][26][27][28][29][30][31][32] Thus, the WHO criteria for AKI in severe malaria vastly underestimates AKI in pediatric populations and does not align with current global standards. Revisions should be considered to reflect current evidence and to harmonize definitions and terminology with consensus classifications.…”

Section: Sensitivity Of the World Health Organization (Who) Criteria For Renal Impairment To Detect Akimentioning

confidence: 99%

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Malaria-Associated Acute Kidney Injury in African Children: Prevalence, Pathophysiology, Impact, and Management Challenges

Batte¹,

Berrens²,

Murphy³

et al. 2021

IJNRD

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Acute kidney injury (AKI) is emerging as a complication of increasing clinical importance associated with substantial morbidity and mortality in African children with severe malaria. Using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria to define AKI, an estimated 24-59% of African children with severe malaria have AKI with most AKI community-acquired. AKI is a risk factor for mortality in pediatric severe malaria with a stepwise increase in mortality across AKI stages. AKI is also a risk factor for postdischarge mortality and is associated with increased long-term risk of neurocognitive impairment and behavioral problems in survivors. Following injury, the kidney undergoes a process of recovery and repair. AKI is an established risk factor for chronic kidney disease and hypertension in survivors and is associated with an increased risk of chronic kidney disease in severe malaria survivors. The magnitude of the risk and contribution of malaria-associated AKI to chronic kidney disease in malaria-endemic areas remains undetermined. Pathways associated with AKI pathogenesis in the context of pediatric severe malaria are not well understood, but there is emerging evidence that immune activation, endothelial dysfunction, and hemolysis-mediated oxidative stress all directly contribute to kidney injury. In this review, we outline the KDIGO bundle of care and highlight how this could be applied in the context of severe malaria to improve kidney perfusion, reduce AKI progression, and improve survival. With increased recognition that AKI in severe malaria is associated with substantial post-discharge morbidity and long-term risk of chronic kidney disease, there is a need to increase AKI recognition through enhanced access to creatinine-based and nextgeneration biomarker diagnostics. Long-term studies to assess severe malaria-associated AKI's impact on long-term health in malaria-endemic areas are urgently needed.

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“…The rise in cases may also represent altered immunopathology as a result of successful malaria control programmes [21]. In contrast, studies in Ghanaian and Nigerian children with malaria only detected an AKI prevalence of 5 % and 3.3 % respectively [23]. This discrepancy in the importance of MAKI in different populations may be due to differences in biological or socio-economic factors [20,21,24].…”

Section: Introductionmentioning

confidence: 99%

Malaria is the Leading Cause of Acute Kidney Injury Among Children Undergoing Dialysis in Lusaka, Zambia: a Retrospective Study

Mwaba

Munsaka

Bvulani

et al. 2023

Preprint

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Background: Recent studies have shown a shift in the traditional aetiologies commonly associated with tropical acute kidney injury (AKI) in some parts of Africa. In many low-income regions limited access to dialysis increases the risk of AKI-associated adverse outcomes. The goal of this study was to evaluate the aetiology, predictors of the need for dialysis, and outcomes of AKI among children evaluated by the renal service in Lusaka, Zambia. Methods: This retrospective study included children less than 16 years old, who were diagnosed with AKI between 2016 and 2021 and followed up by the renal service at the University Teaching Hospitals- Children’s hospital (UTH-CH). AKI was defined and staged using the KDIGO 2012 criteria. Data were extracted from patient folders using a pre-designed tool and then analysed using SPSS version 25. Categorical data were expressed as simple proportions while continuous variables were expressed as either means or median after determination of normality. Correlations were determined using the chi-square test, otherwise Fischer’s exact test in the case of categorical variables, and the independent t-test for continuous variables. The significance level was set at a p-value < 0.05. The predictors of need for dialysis, poor patient outcome, and malaria-associated AKI (MAKI) were identified by using binary logistic regression. Results: The 126 (37.7%) children diagnosed with AKI had a median age of 7.5 (interquartile range 0.3-16) yearsand a male-to-female ratio of 1.4. Of these, a total of 94(74.6%) underwent dialysis with 65(82.1%) receiving peritoneal dialysis (PD), 8(8.5%) receiving haemodialysis (HD), and 4(4.3%) undergoing both modalities. Predictors of need for dialysis were oliguria (OR 10.4, p= 0.002) and anuria (OR 8.7, p, 0.006) while the leading aetiologies of AKI were malaria (77, 60%) and glomerular disease (21, 16.6%). Twenty-three (18.3 %) children developed chronic kidney disease (CKD), 7(5.6 %) died and a year later 97 (77%) were lost to follow-up. Conclusion: Malaria is the leading cause of AKI and children from areas of medium malaria transmission intensity are at increased risk. Three-quarters of children in the cohort required dialysis. CKD and mortality rates may be underestimated due to the high loss to follow- up rate.

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Acute kidney injury in pediatric patients with malaria: A prospective cross-sectional study in the shai-osudoku district of Ghana

Cited by 3 publications

References 14 publications

Epidemiological, Clinical, Therapeutic, and Evolutionary Aspects of Acute Kidney Damage during Severe Malaria in Children at the Borgou Departmental Teaching Hospital (Benin)

Epidemiological, Clinical, Therapeutic, and Evolutionary Aspects of Acute Kidney Damage during Severe Malaria in Children at the Borgou Departmental Teaching Hospital (Benin)

Malaria-Associated Acute Kidney Injury in African Children: Prevalence, Pathophysiology, Impact, and Management Challenges

Malaria is the Leading Cause of Acute Kidney Injury Among Children Undergoing Dialysis in Lusaka, Zambia: a Retrospective Study

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