Acute kidney injury in the tropics

Abstract

The tropics are a region consisting of more than 125 countries, accounting for 40% of the world's population. The region's population is expected to increase up to 60% in the coming decades. Many tropical countries continue to experience public health problems such as high rates of infectious diseases, lack of sanitation, climate change impacts, poor regulation of herbal medicines and low access to healthcare. These conditions produce the unique problem of tropical acute kidney injury (AKI), which is associated with high morbidity and mortality. Tropical infections such as leptospirosis, dengue and malaria have varied mechanisms of AKI, including both direct kidney invasion and indirect effects, depending on the disease characteristics. Animal toxins from snakebites and arthropods along with plant toxins, such as djenkol beans, starfruit and herbal medicine, are characterized by a harmful renal effect from each toxic substance. Environmental factors such as heat stress, natural disasters and chemical compounds also lead to AKI and have a systemic effect from their own pathogenesis. The long‐term kidney prognosis varies among these etiologies depending on the cause and severity of disease. However, all these conditions are potentially preventable and treatable. Prompt management and good preventive approaches are needed. This article will focus on the epidemiology, pathogenesis and management of AKI associated with tropical infections, toxins and environment impacts.

Acute Kidney Injury Associated with Severe Leptospirosis: Fatal Re-Emerging Disease in Latin America

“…Among the findings of the urinalysis are pyuria, hematuria, bile pigments, granular casts, and mild proteinuria [6]. Hypokalemia and magnesiuria continue to be the most important findings, which can be found in 40-87% and 75% of cases, respectively [57]. Hyponatremia is also notable in leptospirosis (frequency); however, together with hypokalemia, it is characteristic of the disease [10].…”

Common arboviruses and the kidney: a review

“…Supportive therapy along with fluid administration is the mainstay treatment for dengue. There is an ongoing debate about the use of parenteral corticosteroids in severe dengue 65 . There is a WHO guideline for dengue management 64 .…”

“…A terapia de suporte, juntamente com a administração de líquidos, é o principal tratamento para a dengue. Há um debate contínuo sobre o uso de corticosteroides parenterais na dengue grave 65 . Existe uma diretriz da OMS para o manejo da dengue 64 .…”

Acute Kidney Injury Associated with Severe Leptospirosis: Fatal Re-Emerging Disease in Latin-America

“…Among the findings of the urinalysis are pyuria, hematuria, bile pigments, granular casts, and mild proteinuria [6]. Hypokalemia and magnesiuria continue to be the most important findings, which can be found in 40%-87% and 75% of cases respectively [45]. Hyponatremia is also notable in leptospirosis (frequency), however, together with hypokalemia it is characteristic of the disease [10].…”