title: Acute kidney injury in imported Plasmodium falciparum malaria.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a known complication of malaria, and is reported to occur in up to 40% of adult patients with a severe Plasmodium falciparum infection in endemic regions. To gain insight in the incidence and risk factors of AKI in imported P. falciparum malaria, a retrospective analysis was performed on a large cohort of mostly non-immune patients with imported P. falciparum malaria. Aiming to include not only severe but also milder forms of renal failure, the KDIGO criteria were used to define AKI.
  
  
  METHODS
  Clinical and laboratory data from 485 consecutive cases of imported P. falciparum malaria were extracted from the Rotterdam Malaria Cohort database. Acute kidney injury (AKI) was defined using the KDIGO criteria. Univariate and multivariate logistic regression analyses were used to identify risk factors for AKI.
  
  
  RESULTS
  AKI was seen in 39 (8%) of all patients and in 23 (38%) of the 61 patients with severe malaria. Eight patients eventually needed renal replacement therapy (RRT); seven of them already had AKI at presentation. Higher age, higher leucocyte count and thrombocytopaenia were independently-associated with AKI but their positive predictive values were relatively poor.
  
  
  CONCLUSIONS
  AKI was found to be a common complication in adults with imported P. falciparum necessitating RRT in only a small minority of patients. The use of the KDIGO staging allows early recognition of a decline in renal function.
authors.affiliation: Institute for Tropical Diseases, Harbour Hospital, Haringvliet 2, 3011 TD, Rotterdam, The Netherlands. l.c.koopmans@student.rug.nl.
authors.forename: Liese C
authors.initials: LC
authors.lastname: Koopmans
authors.affiliation: Institute for Tropical Diseases, Harbour Hospital, Haringvliet 2, 3011 TD, Rotterdam, The Netherlands. mvanwolfswinkel@gmail.com.|Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands. mvanwolfswinkel@gmail.com.
authors.forename: Marlies E
authors.initials: ME
authors.lastname: van Wolfswinkel
authors.affiliation: Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands. d.a.hesselink@erasmusmc.nl.
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Hesselink
authors.affiliation: Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands. e.j.hoorn@erasmusmc.nl.
authors.forename: Ewout J
authors.initials: EJ
authors.lastname: Hoorn
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands. Rob.Koelewijn@havenziekenhuis.nl.
authors.forename: Rob
authors.initials: R
authors.lastname: Koelewijn
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands. j.vanhellemond@erasmusmc.nl.
authors.forename: Jaap J
authors.initials: JJ
authors.lastname: van Hellemond
authors.affiliation: Institute for Tropical Diseases, Harbour Hospital, Haringvliet 2, 3011 TD, Rotterdam, The Netherlands. p.van.genderen@havenziekenhuis.nl.
authors.forename: Perry J J
authors.initials: PJ
authors.lastname: van Genderen
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology* / Q000469:parasitology* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D012307:Risk Factors; D014195:Travel; D055815:Young Adult