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Published on: July 17, 2016
Malaria-Associated Acute Kidney Injury in African Children: Prevalence, Pathophysiology, Impact, and Management
Anthony Batte1, Zachary Berrens2, Kristin Murphy3
1Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda.
Insights
Acute kidney injury (AKI) in African children with severe malaria is common and increases mortality risk. Early recognition and intervention are crucial for improving outcomes and reducing long-term kidney disease risks.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Public Health
Background:
- Acute kidney injury (AKI) is a significant complication in African children with severe malaria, leading to high morbidity and mortality.
- An estimated 24-59% of these children are affected, with most cases acquired in the community.
- AKI is a predictor of mortality during hospitalization, post-discharge, and is linked to long-term neurocognitive issues.
Purpose of the Study:
- To review the current understanding of AKI in pediatric severe malaria.
- To discuss the application of Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for AKI management in this context.
- To highlight the need for improved diagnostics and long-term follow-up studies.
Main Methods:
- Literature review focusing on AKI in pediatric severe malaria.
- Analysis of existing data on AKI prevalence and outcomes.
- Discussion of pathogenic pathways including immune activation, endothelial dysfunction, and oxidative stress.
Main Results:
- AKI significantly increases mortality risk in pediatric severe malaria patients.
- Survivors face increased risks of chronic kidney disease, hypertension, and neurocognitive impairment.
- Pathogenesis involves complex interactions of immune, endothelial, and hemolytic factors.
Conclusions:
- The KDIGO bundle of care offers a framework to improve AKI management and outcomes in severe malaria.
- Enhanced diagnostic tools and long-term studies are essential to address the burden of AKI and its sequelae.
- There is an urgent need to increase AKI recognition and management in malaria-endemic regions.
Abstract:
Acute kidney injury (AKI) is emerging as a complication of increasing clinical importance associated with substantial morbidity and mortality in African children with severe malaria. Using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria to define AKI, an estimated 24-59% of African children with severe malaria have AKI with most AKI community-acquired. AKI is a risk factor for mortality in pediatric severe malaria with a stepwise increase in mortality across AKI stages. AKI is also a risk factor for post-discharge mortality and is associated with increased long-term risk of neurocognitive impairment and behavioral problems in survivors. Following injury, the kidney undergoes a process of recovery and repair. AKI is an established risk factor for chronic kidney disease and hypertension in survivors and is associated with an increased risk of chronic kidney disease in severe malaria survivors. The magnitude of the risk and contribution of malaria-associated AKI to chronic kidney disease in malaria-endemic areas remains undetermined. Pathways associated with AKI pathogenesis in the context of pediatric severe malaria are not well understood, but there is emerging evidence that immune activation, endothelial dysfunction, and hemolysis-mediated oxidative stress all directly contribute to kidney injury. In this review, we outline the KDIGO bundle of care and highlight how this could be applied in the context of severe malaria to improve kidney perfusion, reduce AKI progression, and improve survival. With increased recognition that AKI in severe malaria is associated with substantial post-discharge morbidity and long-term risk of chronic kidney disease, there is a need to increase AKI recognition through enhanced access to creatinine-based and next-generation biomarker diagnostics. Long-term studies to assess severe malaria-associated AKI's impact on long-term health in malaria-endemic areas are urgently needed.
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