Malarial nephropathy is

kidney failure Kidney failure, also known as end-stage kidney disease, is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels. Kidney failure is classified as eit ...

attributed to

malaria Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases, it can cause jaundice, seizures, coma, or death. S ...

l infection. Among various complications due to infection, renal-related disorders are often the most life-threatening.Barsoum, Rashad S. “Malarial Acute Renal Failure.” J Am Soc Nephrol 11 (2000): 2147-2154. Including malaria-induced renal lesions, infection may lead to both tubulointerstitial damage and

glomerulonephritis Glomerulonephritis (GN) is a term used to refer to several kidney diseases (usually affecting both kidneys). Many of the diseases are characterised by inflammation either of the glomeruli or of the small blood vessels in the kidneys, hence the ...

.Das, B.S. “Renal failure in malaria.” J Vector Borne Dis. 45 (2008): 83-97. In addition, malarial acute kidney failure has emerged as a serious problem due to its high mortality rate in non-immune adult patients.Manan, Junejo Abdul, Hassan Ali, and Manohar Lal. “Acute Renal Failure Associated with Malaria.” J Ayub Med Coll Abbottabad 4 (2006): 47-52.

Mechanism

Due to the complex malarial syndrome, there are many pathogenic interactions leading to acute renal failure, such as

hypovolemia Hypovolemia, also known as volume depletion or volume contraction, is a state of abnormally low extracellular fluid in the body. This may be due to either a loss of both salt and water or a decrease in blood volume. Hypovolemia refers to the los ...

intravascular hemolysis Intravascular hemolysis describes hemolysis that happens mainly inside the vasculature. As a result, the contents of the red blood cell are released into the general circulation, leading to hemoglobinemia and increasing the risk of ensuing hyperbili ...

and disseminated intravascular coagulation. Malarial acute renal failure prevents the kidneys from efficiently removing excess fluid,

electrolytes An electrolyte is a medium containing ions that is electrically conducting through the movement of those ions, but not conducting electrons. This includes most soluble salts, acids, and bases dissolved in a polar solvent, such as water. Upon di ...

and waste material from the blood. The accumulation of these fluids and material will cause adverse consequences for the patient including, electrolyte abnormality and increased urinary protein excretion.

Diagnosis

Treatment

Untreated patients often face a large number of physical complications, but early diagnosis and effective treatment can reduce the high risk of mortality in patients. A three-pronged approach against infection is regularly needed for successful treatment.

antimalarial drug Antimalarial medications or simply antimalarials are a type of antiparasitic chemical agent, often naturally derived, that can be used to treat or to prevent malaria, in the latter case, most often aiming at two susceptible target groups, young c ...

therapy (e.g., artemisinin derivatives), fluid replacement (e.g., oral rehydration therapy), and if needed, renal replacement therapy.

Epidemiology

Malarial nephropathies are reported in endemic areas, such as Southeast Asia, India, and Sub-Saharan Africa. The pathogenesis of

acute kidney injury Acute kidney injury (AKI), previously called acute renal failure (ARF), is a sudden decrease in kidney function that develops within 7 days, as shown by an increase in serum creatinine or a decrease in urine output, or both. Causes of AKI are cla ...

in severe malaria is unspecific and multifactorial—it affects fewer than 4.8 percent of cases, but reports a high risk of mortality (15 to 45 percent). Histologic evidence shows a large combination of pathogenic mechanisms at play—

acute tubular necrosis Acute tubular necrosis (ATN) is a medical condition involving the death of tubular epithelial cells that form the renal tubules of the kidneys. Because necrosis is often not present, the term acute tubular injury (ATI) is preferred by pathologists ...

interstitial nephritis Interstitial nephritis, also known as tubulointerstitial nephritis, is inflammation of the area of the kidney known as the renal interstitium, which consists of a collection of cells, extracellular matrix, and fluid surrounding the renal tubules. ...

and

. Risk factors for malarial acute kidney injury include delayed diagnosis, high

parasitemia Parasitemia is the quantitative content of parasites in the blood. It is used as a measurement of parasite load in the organism and an indication of the degree of an active parasitic infection. Systematic measurement of parasitemia is important in ...

, and clinical presentation of

oliguria Oliguria or hypouresis is the low output of urine specifically more than 80 ml/day but less than 400ml/day.Boon et al, Davidson's Principles & Practice of Medicine (20th Ed), p475 The decreased output of urine may be a sign of dehydration, kidney ...

, low blood pressure, severe

anemia Anemia or anaemia (British English) is a blood disorder in which the blood has a reduced ability to carry oxygen due to a lower than normal number of red blood cells, or a reduction in the amount of hemoglobin. When anemia comes on slowly, th ...

, and

jaundice Jaundice, also known as icterus, is a yellowish or greenish pigmentation of the skin and sclera due to high bilirubin levels. Jaundice in adults is typically a sign indicating the presence of underlying diseases involving abnormal heme meta ...

. In addition, patients already suffering from diarrhea, hepatitis, or respiratory distress have a worse prognosis.

References

{{Reflist Malaria Kidney diseases