A new review by Conroy, Datta, and John highlights the connection between the kidneys and malaria on this World Kidney Day. They explain that “15 years ago, renal failure was considered a rare complication in children with Severe Malaria, yet it is now recognized as one of the strongest predictors of mortality in severe malaria.”
While severe malaria is related to reduced kidney perfusion, Conroy et al. note that, “additional studies are needed to evaluate the spectrum of AKI over hospitalization to define the etiology and pathophysiology of acute kidney injury in pediatric severe malaria.” In the diagram to the right, they show that kidney involvement is among the most deadly forms of severe malaria.
These problems are not limited to Africa. Dayanand and colleagues describe “single or multi-organ dysfunction involving liver, kidney, and brain” occurring in Mangaluru, India.
Brown et al. warn travelers including people returning to endemic areas after a long absence to be aware of severe malaria dangers once they return to non-endemic countries. “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.”
The World Health Organization’s Third Edition on its guidelines on managing severe malaria addresses acute kidney injury with attention to reversing dehydration, addressing reduced urine output and even the need for dialysis. Clearly the best response is prompt diagnosis and treatment when malaria is in its very early stages, and better yet, using insecticide treated bednets to prevent the problem in the first place.