Malaria and Acute Kidney Disease  

By Dr Seera Pani Gopaluni, Consultant Nephrologist, NephroPlus & Citizens Hospital
 
Malaria, a disease spread by mosquitoes, is caused by a parasite called Plasmodium. Typical symptoms of malaria include high-grade fever and chills. It is one of the most common infectious diseases globally and inflicts a huge burden on the public health systems in many developing countries. According to the latest World Health Organization’s (WHO) World Malaria Report, on average 247 million cases of malaria are reported every year. While most cases show mild symptoms, a minority of cases could be fatal. The estimated number of malarial deaths stood at 6,19,000 in 2021.
 

In severe malarial disease, multi-organ dysfunction affecting organs such as the lungs, kidneys, and brain is common. Acute kidney injury (AKI) is a known complication of malaria and could occur in around 40% of patients with severe disease. In children, the incidence is reported at approximately 10%. AKI caused due to malaria can lead to immune dysregulation and inflammation and can contribute to physical and mental ailments.
 

Severe malaria causes damage to fine urinary tubes within the kidney, a condition called acute tubular necrosis.  AKI is defined by increased creatinine by more than 0.3 mg/dl within 48 hours or a reduction in urine volume to less than 0.5ml/kg/hour for 6 hours. In most cases, AKI due to malaria is reversible if treated early.
 

At the onset, mild laboratory abnormalities such as reduced haemoglobin, higher white cell count, low platelets, elevated ESR, liver enzyme abnormalities, and electrolyte (salts) disturbances may occur. With worsening disease severe symptoms related to anaemia, liver disease and acute kidney injury may manifest. Reduced kidney function may result in the build-up of fluids, waste products or disturbances in salts like sodium and potassium. Splenic rupture is a much more serious problem occurring in a minority of individuals with AKI and severe malaria. Symptoms, as well as the severity of the disease, can vary from individual to individual. Seeking professional medical help at the earliest and appropriate investigations can lead to a rapid diagnosis. Initiating therapy at the outset can contain the disease and prevent progression to a severe disease state.
 

Given the significant morbidity associated with AKI secondary to malaria, it is imperative to have access to expert nephrologists, as such situations need close monitoring and treatment. There is a possibility of patients with severe AKI needing temporary dialysis therapy to deal with fluid overload and salt disturbances. Emphasis on bridging the significant health literacy gap is needed to effectively tackle the complications related to malaria, especially AKI. As we move into a fast-paced world it is important to prioritize one’s health by having regular check-ups to detect clinical irregularities (if any) and take precautions accordingly. These tests also draw attention to any abnormalities that might lead to chronic illnesses.

 
Kidney disease remains a huge burden on society, and it is estimated that about 10% of the adult population has some form of kidney disease. Approximately 220,000 people have severe kidney disease (end-stage kidney disease) needing dialysis every year and the lack of access and affordability to renal replacement therapy in the form of dialysis or transplantation to the majority is unfortunate. These staggering numbers should draw the attention of the public and government to stem the epidemic of kidney disease at its roots.