Infection-associated acute kidney injury in resource-limited settings

Acute kidney injury (AKI) is a frequent and life-threatening complication of infection, and a major contributor to preventable morbidity and mortality in resource-limited settings. In these contexts, AKI is commonly driven by a broad range of infections, including enteric, zoonotic and vector-borne diseases, that occur outside the hospital and in populations with limited access to diagnostics and supportive care. Infection-associated AKI results from diverse and overlapping mechanisms, including hypovolaemia, inflammation, endothelial and microcirculatory dysfunction, haemolysis and direct kidney involvement, and is increasingly shaped by environmental stressors such as heat exposure and climate-related disruptions that amplify dehydration, infection risk and kidney injury. Susceptibility to AKI is further influenced by reduced kidney reserve, which reflects nephron endowment and prior kidney injury, and can be silently depleted by severe or recurrent insults. Repeated infectious exposures and incomplete recovery from AKI might affect long-term kidney health and survival, but these trajectories remain poorly characterized. Challenges in timely recognition of both AKI and infections contribute to delayed treatment and worse outcomes, particularly among vulnerable populations. Strengthening infection prevention, improving context-appropriate diagnostics for AKI and infection, minimizing iatrogenic kidney injury, addressing environmental drivers and developing affordable scalable kidney replacement therapies are essential to reducing inequities and improving long-term kidney health globally.