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Renal involvement in Gambian children with cerebral or mild malaria
M W Weber1, U Zimmermann, M B van Hensbroek
1Medical Research Council Laboratories, Fajara, The Gambia. weberm@who.ch
Insights
Kidney problems are common in Gambian children with cerebral malaria, showing increased protein in urine and elevated serum creatinine. However, this renal dysfunction is mild and does not worsen the prognosis.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Malariology
Background:
- Cerebral malaria is a severe complication of Plasmodium falciparum infection.
- Renal impairment is a known complication of severe malaria, but its spectrum in children requires further elucidation.
- Understanding kidney involvement is crucial for managing pediatric malaria.
Purpose of the Study:
- To investigate the prevalence and patterns of kidney dysfunction in Gambian children with cerebral malaria compared to mild malaria and other febrile illnesses.
- To assess the relationship between renal impairment and clinical parameters like fever, parasitemia, and prognosis.
Main Methods:
- Cross-sectional study involving 80 children with cerebral malaria, 73 with mild malaria, and 19 with other febrile illnesses.
- Measurement of serum creatinine levels.
- Determination of urinary excretion of immunoglobulin G, transferrin, albumin, and alpha 1 microglobulin.
Main Results:
- Elevated serum creatinine (>62 µmol/l) was observed in 25% of cerebral malaria cases and 4% of mild malaria cases.
- Proteinuria was frequent, with 53% showing a glomerulo-tubular pattern and 46% a tubular pattern in cerebral malaria.
- Median albuminuria was significantly higher in cerebral malaria (68 mg/l) compared to mild malaria (18 mg/l) and other febrile illnesses (9 mg/l) (P < 0.0001).
- No significant association was found between proteinuria and fever height or parasitemia, nor between renal impairment and mortality.
Conclusions:
- Renal involvement is common in children with malaria in The Gambia, affecting glomerular and tubulo-interstitial functions.
- Kidney dysfunction is more pronounced in cerebral malaria than in mild malaria.
- Despite its prevalence, renal dysfunction in pediatric malaria appears relatively mild and does not negatively impact the prognosis.
Abstract:
Kidney function was studied in 80 Gambian children with cerebral malaria, 73 children with mild malaria, and in 19 children with other febrile illnesses. Serum creatinine was measured, and the excretion in urine of immunoglobulin G, transferrin, albumin and alpha 1 microglobulin was determined. Twenty-five percent of children with cerebral malaria, and 4% of children with mild malaria had an elevated serum creatinine above 62 mumol/l. Increased urinary protein excretion was frequent: 53% of children with cerebral malaria had a glomerulo-tubular pattern of protein excretion, and 46% a tubular pattern. Median albuminuria was 68 mg/l in children with cerebral malaria, 18 mg/l in children with mild malaria, and 9 mg/l in febrile children with other diseases (P < 0.0001). There was no significant association between the proteinuria and height of fever or the degree of parasitaemia, and there was no significant association between death and signs of renal impairment. Renal involvement is common in children with malaria in The Gambia, with prerenal, glomerular, and tubulo-interstitial factors contributing. It is more pronounced in children with cerebral malaria than in those with mild malaria. However, renal dysfunction is relatively mild and does not indicate a worse prognosis.