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Acute Kidney Injury Is Common in Pediatric Severe Malaria and Is Associated With Increased Mortality

Andrea L Conroy1, Michael Hawkes2, Robyn E Elphinstone3

  • 1Sandra A. Rotman Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, University of Toronto, Canada; Department of Pediatrics, Indiana University, Indianapolis.

Open Forum Infectious Diseases
|May 18, 2016
PubMed

Insights

Acute kidney injury (AKI) is common in pediatric severe malaria (SM), affecting 45.5% of children. AKI is linked to longer hospital stays and increased mortality, especially in the placebo group.

Area of Science:

  • Pediatric Nephrology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Acute kidney injury (AKI) is a known complication of severe malaria (SM) in adults.
  • The incidence and clinical significance of AKI in pediatric SM are not well-documented.

Purpose of the Study:

  • To investigate the incidence and clinical importance of AKI in children with SM.
  • To assess the association of AKI with outcomes such as neurodisability and mortality.

Main Methods:

  • 180 children (1-10 years) with SM in Uganda were monitored for kidney function using serum creatinine (Cr) daily for 4 days.
  • AKI was defined by KDIGO guidelines. Blood urea nitrogen (BUN) and cystatin C (CysC) were also measured.

Main Results:

  • 45.5% of children (81/180) had KDIGO-defined AKI, with 50% developing it after admission.
  • AKI risk was higher in the inhaled nitric oxide (iNO) group (54.0% vs 37.4% placebo).
  • AKI correlated with longer hospitalization, neurodisability (placebo group), and increased mortality (placebo group), with stage 3 AKI reaching 37.5% mortality.

Conclusions:

  • AKI is an underrecognized complication in pediatric SM.
  • AKI is associated with increased mortality in children with SM.
  • Kidney biomarkers predict mortality in pediatric SM.

Keywords:
acute kidney injurychildrencreatinineinhaled nitric oxidesevere malaria

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