title: Acute Kidney Injury in Children with Plasmodium falciparum Malaria: Determinants for Mortality.
abstract: ♦
  
  
  BACKGROUND
  Acute kidney injury (AKI) in P. falciparum malaria infection is an important morbidity in children. The purpose of the present study was done to observe the renal involvement, associated morbidities and outcome. ♦
  
  
  METHODS
  Out of 156 patients with severe P. falciparum malaria, diagnosed on the basis of compatible clinical presentations and positive malarial parasites in the peripheral blood smear and/or histidine rich protein 2 antigen, 31 had AKI at presentation and were analyzed. ♦
  
  
  RESULTS
  Of 31 (19.9%) patients with AKI, 4 were classified at risk, 11 injury, and 16 failure stage, as per pRIFLE criteria (pediatric version of RIFLE [R = risk, I = injury, F = failure, L = loss E = end-stage kidney disease]). Mean age of children with AKI was 7.7 ± 3.2 years. A significantly higher proportion of patients with AKI had hypoglycemia (41.9%), pulmonary edema (32.2%), and disseminated intravascular coagulation (DIC) (29.0%) compared to those without AKI (18.4%, 4.8%, and 3.2%, respectively). Twelve patients (38.7%) required peritoneal dialysis (PD), 8 (25.8%) died, and all were in failure stage. The non-survivors had significantly higher blood urea (p = 0.005) and serum creatinine levels (p = 0.042), lower glomerular filtration rate (p < 0.001), longer duration of illness (p = 0.003), and oliguria/anuria (p = 0.001) than survivors at admission. On logistic regression analysis, the disseminated intravascular coagulation (DIC), jaundice and parasite density (≥ 3+) were found to be significant factors contributing to mortality in children with AKI. ♦
  
  
  CONCLUSIONS
  Acute kidney injury in falciparum malaria is one of the severe systemic complications. Duration of illness and presence of comorbidities adversely affected the outcome.
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India.
authors.forename: Rajniti
authors.initials: R
authors.lastname: Prasad
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India opmpedia@yahoo.co.uk.
authors.forename: Om P
authors.initials: OP
authors.lastname: Mishra
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000401:mortality / Q000469:parasitology*; D000293:Adolescent; D000953:Antigens, Protozoan / Q000097:blood; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D016015:Logistic Models; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000401:mortality / Q000469:parasitology*; D008297:Male; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D015800:Protozoan Proteins / Q000097:blood; D012307:Risk Factors
chemical_list: D000953:Antigens, Protozoan; C514457:HRP-2 antigen, Plasmodium falciparum; D015800:Protozoan Proteins
keywords: AKI; falciparum malaria; mortality