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Renal function in acute falciparum malaria
1Department of Pharmacology and Therapeutics, University of Ibadan, Nigeria.
Insights
Falciparum malaria in children can cause acute kidney injury, even in uncomplicated cases. Renal function impairment, including reduced creatinine clearance and tubular dysfunction, was observed during acute illness and improved after recovery.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Malariology
Background:
- Falciparum malaria is a significant global health concern, particularly in children.
- Renal complications are known but often associated with severe malaria.
- The impact on renal function in uncomplicated falciparum malaria requires further elucidation.
Purpose of the Study:
- To assess renal function in children during acute falciparum malaria and after recovery.
- To identify specific patterns of renal impairment and dysfunction.
- To correlate renal function parameters with disease severity markers.
Main Methods:
- Prospective study involving 40 children with falciparum malaria.
- Assessment of renal function parameters including creatinine clearance, fractional sodium excretion (FeNa), and fractional potassium excretion (FeK).
- Evaluation of hyponatremia, proteinuria, and tubular dysfunction during acute illness and post-recovery.
Main Results:
- Significantly lower creatinine clearance during acute illness compared to recovery.
- Evidence of acute tubular dysfunction in children with impaired creatinine clearance.
- Hyponatremia (12.5%) and increased FeNa (27%) during acute phase; persistent sodium wastage in 17% post-recovery.
- Elevated plasma potassium and lower FeK during acute illness.
- Mild proteinuria in 40% during acute illness, resolving upon recovery.
Conclusions:
- Acute intrinsic renal impairment occurs in children with apparently uncomplicated falciparum malaria.
- Renal function deficits, including tubular dysfunction and electrolyte imbalances, are common.
- These findings highlight the importance of monitoring renal function in pediatric malaria cases.
Abstract:
Renal function was assessed in 40 children during the acute illness and after recovery from falciparum malaria. Creatinine clearance was significantly lower during the acute illness than after recovery. Six of 18 children with impaired creatinine clearance (< 50 ml/min/1.73 m2) had evidence of acute tubular dysfunction. Hyponatraemia occurred in 12.5% during the acute phase. Fractional sodium excretion was raised in 27% during the acute illness and continuing sodium wastage occurred in 17% after recovery. Plasma potassium was significantly higher and fractional potassium excretion (FeK) significantly lower during the acute illness than after recovery. There was a positive correlation between FeNa and FeK both during and after recovery from the illness but they did not exactly mirror each other in every individual. Urine sodium:potassium ratios were similar during and after recovery from the illness and was related to FeNa. Fractional glucose excretion was zero. Mild proteinuria occurred in 40% during the acute illness but were not related to creatinine clearance, body temperature at presentation, or peripheral parasite density. Proteinuria was absent after recovery. Acute intrinsic renal impairment occurs during apparently 'uncomplicated' falciparum malaria in children.