Malaria and acute kidney injury

Abstract

Malaria is a parasitic infection transmitted by mosquitos, resulting in significant morbidity and mortality. It affects 212 million worldwide, causing death in up to 303,000 children annually. In the USA, up to 1700 people are affected yearly. Although the prevalence in developed countries is less than in developing countries, travelers from low transmission areas, and those from endemic areas who later return, are very susceptible to malaria and its complications. Severe malaria can cause significant multiorgan dysfunction including acute kidney injury (AKI). The pathogenesis is not clearly understood but proposed mechanisms include acute tubular necrosis (ATN) due to impediments in renal microcirculation, infection-triggered proinflammatory reactions within the kidney, and metabolic disturbances. Providers must consider malarial infection in cases of AKI in someone with a travel history, as early recognition and treatment are crucial to improving outcomes. This article will review malariainduced AKI in order to provide a better understanding of this infection's effect on the kidneys.

Immunopathology of Acute Kidney Injury in Severe Malaria

“…Multiple studies have identified malaria as one of the most frequent etiologies of pediatric AKI cases in developing countries (58). Importantly, both adult and pediatric studies have shown that when AKI occurs in the context of malaria, there is an increase in patient mortality (59,60). One of the key questions that remains to be answered is whether AKI plays a causal role in SM deaths, or if it is a consequence of pathological processes which lead to death through their effects on other organs.…”

Antimalarial Effect of the Total Glycosides of the Medicinal Plant, Ranunculus japonicus

“…Reduced serum levels of AST, ALT, total bilirubin, and indirect bilirubin observed in response to treatment suggest that R. japonicus could protect P. berghei -infected animals against liver damage, thus improving their clinical status. Moreover, malaria infection also results in renal damage due to alteration of renal blood circulation caused by conformational changes of parasitized erythrocytes, increased blood viscosity, and cytoadherence of infected erythrocytes [ 23 ]. The observed decreases in serum levels of urea and creatinine suggest that reductions in parasitemia in response to administration of the RJE may also prevent erythrocyte adherence, high blood viscosity, dysfunctional renal blood circulation, and subsequent renal injury.…”

Acute Kidney Injury and Jaundice in a Patient With Concurrent Severe Malaria and Acute Exacerbation of Hepatitis B

“…The mortality rate of malaria-associated AKI reached up to 51%, and worst prognosis was associated with delayed referral, severe jaundice, oliguria, and multi-organ involvement. 12 The pathogenesis of AKI is believed to be caused by infected red blood cell (RBC) sequestration in the renal vasculature leading to hypoperfusion and tissue hypoxia, combined with immune complex deposition in renal tubules. Malaria-induced AKI manifests pathologically as acute tubular necrosis.…”

“…Diagnosis of AKI is suspected when urine output falls to <400 mL/24 hours and should be confirmed when serum creatinine level reaches 3 mg/dL or higher. 12 Jaundice is another common manifestation of severe malaria. Jaundice associated with malaria is often biphasic in nature, with elevation of both conjugated and nonconjugated bilirubin contributed by cholestasis and hemolysis of RBC, respectively.…”