The clinical and biochemical features of complicated falciparum malarial nephropathy

Objective: This study aimed to explore renal involvement in complicated falciparum malaria as observed in hospitalized children.

Methods: This prospective study was conducted for four consecutive years with children 6 months to 14 years old who were affected by malarial nephropathy. Malaria was confirmed by microscopic examination of a blood smear. Detailed clinical evaluation and investigations were carried out to determine multi-organ involvement with special emphasis on renal functions. The staging for Acute Kidney Injury (AKI) was carried out as per Acute Kidney Injury Network Staging, which provided three groups of patients who were further modified by Risk, Injury, Failure, Loss, End stage renal disease (RIFLE) staging.

Results: Out of 350 cases with malaria, 56 (16%) cases had nephropathy. One-hundred-forty cases (40%) were aged between 5 and 10 years. Serious renal involvement was observed in 14 (25%) children who were 10-14 years old. Oligo-anuria was found in 40 (71.4%) cases, and generalized oedema was found in 33 (58.9%) children from the onset of malaria. Approximately 47 cases showed associated multi-organ dysfunction, and 9 cases had isolated renal failure. Malaria-induced hepatopathy and nephropathy had a higher risk of death than nephropathy alone.

Conclusion: The spectrum of malarial nephropathy in children is highly variable, ranging from asymptomatic proteinuria to advanced stages of AKI. Renal involvement is more common and severe in P. falciparum. Children aged between 5 and 14 years and those with oligo-anuria, symptomatic azotaemia, electrolyte abnormalities and hepatopathy are more likely to develop advanced stage AKI and subsequently have an increased risk of mortality.