Acute kidney injury in children with severe malaria

Abstract

Background: Renal involvement in severe malaria has been reported as an important contributor to morbidity and mortality. Acute kidney injury (AKI) is a frequent and life threatening complication of falciparum malaria. This study was undertaken to determine the prevalence and risk factors of AKI in children with severe malaria in Port Harcourt.

Materials and Methods: This was a retrospective study of patients with severe malaria and AKI conducted at the University of Port Harcourt Teaching hospital, Nigeria over a 5-year period (January 2007 to December 2012). We analysed information on biodata, clinical features, investigations, complications, treatment including specific treatment for renal failure and outcome. The estimated glomerular filtration rate (eGFR) was calculated using the modified Schwartz equation.

Results: AKI occurred in 32 of 960 patients with severe malaria giving a prevalence of 3.3%. They were aged 8 months to 9 years with majority (84.4%) less than 60 months. There were more males with a male: female ratio of 1.3:1. Over 80% of the patients had oliguric AKI while 5 (15.6%) patients had non-oliguric AKI. Proteinuria ranging from 30 to 100mg/dl occurred in 19 (59.4%) patients. Twenty-six (81.3%) patients responded to conservative management of AKI while 6 patients (18.8%) received acute peritoneal dialysis for failed conservative treatment (2 patients) and uraemic encephalopathy (4 patients). The duration of oliguria in all patients ranged from 4 - 11 days. Two patients died from uraemic encephalopathy giving a mortality rate of 6.3%.

Conclusion: AKI occurs in Nigerian children with malaria and majority respond well to conservative treatment.

Keywords: Acute kidney injury(AKI), Severe malaria, Plasmodium falciparium, Children, Nigeria