Incidence and predictors of acute kidney injury in children with severe malaria

  • Folake Moriliat Afolayan University of Ilorin, Teaching Hospital, Kwara
  • Olanrewaju Timothy Adedoyin Department of Paediatrics and Child Health, University of Ilorin and University of Ilorin Teaching Hospital,Kwara State
  • Mohammed Baba Abdulkadir Department of Paediatrics and Child Health, University of Ilorin and University of Ilorin Teaching Hospital,Kwara State
  • Olayinka Rasheed Ibrahim Department of Paediatrics, Federal Medical centre, Kastina Nigeria
  • Sikiru Abayomi Biliaminu Department of Chemical Pathology,University of Ilorin and University of Ilorin Teaching Hospital,Kwara State
  • Olugbenga Ayodeji Mokuolu Department of Paediatrics and Child Health, University of Ilorin and University of Ilorin Teaching Hospital,Kwara State
  • Ayodele Ojuawo Department of Paediatrics and Child Health, University of Ilorin and University of Ilorin Teaching Hospital,Kwara State
Keywords: acute kidney injury; pRIFLE; severe malaria; children

Abstract

 


 

Background Acute kidney injury (AKI) is an underrecognized complication of severe malaria and an independent risk factor for mortality among children.

Objective To determine the incidence and factors predictive of AKI as defined by the pediatric risk, injury, failure, loss, and end-stage (pRIFLE) criteria in children with severe malaria and to assess in-hospital mortality rates in malarial AKI (MAKI).

Methods This was a prospective cohort study in 170 children aged 0.5 to 14 years with confirmed Plasmodium falciparum on peripheral blood smears and clinical and/or laboratory features of severe malaria. Serum creatinine was determined using the Jaffe method and glomerular filtration rate (eGFR) was estimated using the Schwartz equation. The primary outcome was the incidence of AKI as defined by the pRIFLE criteria. Secondary outcomes included in-hospital mortality comparison between AKI and non-AKI groups, as well as factors predictive of AKI.

Results The incidence of MAKI was 61.2% (104/170) and was comparable between males (66.7%) and females (70.6%). Mean eGFR was lower among children with AKI than those without [42.00 (SD 22) vs. 98.7 (SD 3.9) mL/min/1.73m2, respectively; P=0.005]. Children with MAKI were categorized as having risk (47/104; 45.2%), injury (33/104; 31.7%), or failure (24/104; 23.1%). Mortality rates in AKI and non-AKI subjects were comparable (4.8% vs. 4.6%; P=0.888). Predictors of MAKI were hemoglobinuria [adjusted OR (aOR) 3.948; 95%CI 1.138 to 8.030], deep acidotic breathing (aOR 2.991; 95%CI 3.549 to 66.898), and longer hospital stay (aOR 2.042; 95%CI 3.617 to 12.156). Children with MAKI were more likely to have a longer hospital stay by a mean of 2.5 days.

Conclusion AKI is a common complication in children with severe malaria. MAKI has a low mortality rate comparable to those with severe malaria but without AKI.  Hemoglobinuria, deep acidotic breathing, and longer hospital stay were predictive of MAKI.

Author Biographies

Olanrewaju Timothy Adedoyin, Department of Paediatrics and Child Health, University of Ilorin and University of Ilorin Teaching Hospital,Kwara State

Adedoyin OT, is a professor of Paediatrics at the University of Ilorin and a consultant Paediatrician at University of Ilorin Teaching Hospital

Mohammed Baba Abdulkadir, Department of Paediatrics and Child Health, University of Ilorin and University of Ilorin Teaching Hospital,Kwara State

Abdulkadir, M.B is a Senior Lecturer at the University of Ilorin and a consultant Paediatrician at University of Ilorin Teaching Hospital

Olayinka Rasheed Ibrahim, Department of Paediatrics, Federal Medical centre, Kastina Nigeria

Ibrahim OR is a consultant paediatrician at the Federal Medical Centre Kastina Nigeria

Sikiru Abayomi Biliaminu, Department of Chemical Pathology,University of Ilorin and University of Ilorin Teaching Hospital,Kwara State

Biliaminu SA is a consultant Chemical Pathologist at the University of Ilorin andUniversity of Ilorin Teaching Hospital

Olugbenga Ayodeji Mokuolu, Department of Paediatrics and Child Health, University of Ilorin and University of Ilorin Teaching Hospital,Kwara State

Mokuolu OA is a professor of Paediatrics at the University of Ilorin and a consultant Paediatrician at University of Ilorin Teaching Hospital

Ayodele Ojuawo, Department of Paediatrics and Child Health, University of Ilorin and University of Ilorin Teaching Hospital,Kwara State

Ojuawo A is a professor of Paediatrics at the University of Ilorin and a consultant Paediatrician at University of Ilorin Teaching Hospital

References

1. World Health Organization. World malaria report 2018. [cited 2020 November 26]. Available from: https://www.who.int/malaria/publications/world-malaria-report-2018/en/.
2. World Health Organization. WHO Malaria Report 2017. [cited 2020 November 26]. Available from: https://www.who.int/docs/default-source/documents/world-malaria-report-2017.pdf?sfvrsn=8b7b573a_0.
3. World Health Organization. Guidelines for the Treatment of Severe Malaria. 2015. [cited 2020 November 26]. Available from: https://www.who.int/docs/default-source/documents/publications/gmp/guidelines-for-the-treatment-of-malaria-eng.pdf.
4. Bellomo R, Kellum JA, Ronco CC. Acute kidney injury. Lancet. 2012;380:756–66. DOI:10.1016/S0140-6736(11)61454-2.
5. Andreoli SP. Acute kidney injury in children. Pediatr Nephrol. 2009;24:253–63. DOI:10.1007/s00467-008-1074-1079
6. Barsoum RS. Malarial acute renal failure. J Am Soc Nephrol. 2000;11:2147–54.
7. Mishra SK, Das BS. Malaria and acute kidney injury. Semin Nephrol. 2008;28:395–408. DOI: 10.1016/j.semnephrol.2008.04.007.
8. Kapoor K, Gupta S. Malarial acute kidney injury in a paediatric intensive care unit. Trop Doct. 2012;42:203–5. DOI:10.1258/td.2012.120196.
9. Koopmans LC, van Wolfswinkel ME, Hesselink DA, Hoorn EJ, Koelewijn R, van Hellemond JJ, et al. Acute kidney injury in imported Plasmodium falciparum malaria. Malar J. 2015;14:523. DOI: 10.1186/s12936-015-1057-9.
10. Conroy AL, Hawkes M, Elphinstone RE, Morgan C, Hermann L, Barker KR, et al. Acute kidney injury is common in pediatric severe malaria and is associated with increased mortality. Open Forum Infect Dis. 2016;3:ofw046. DOI: 10.1093/ofid/ofw046.
11. Oshomah-Bello EO, Esezobor CI, Solarin AU, Njokanma FO. Acute kidney injury in children with severe malaria is common and associated with adverse hospital outcomes. J Trop Pediatr. 2020;66:218–25. DOI: 10.1093/tropej/fmz057.
12. Kellum JA, Lameire N, Aspelin P, Barsoum S, Burdmann EA, Goldstein SL, et al. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1–138. DOI:10.1038/kisup.2012.1.
13. Ricci Z, Cruz DN, Ronco C. Classification and staging of acute kidney injury: beyond the RIFLE and AKIN criteria. Nat Rev Nephrol. 2011;7:201–8. DOI:10.1038/nrneph.2011.14.
14. Kellum JA. Acute kidney injury. Crit Care Med. 2008;36:141–5. DOI:10.1097/CCM.0b013e318168c4a4.
15. Makris K, Spanou L.Acute Kidney Injury: Definition, Pathophysiology and Clinical Phenotypes. Clin Biochem Rev. 2016; 37:85-98.
16. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8;204-12. DOI:10.1186/cc2872.
17. Lopes JA, Jorge S. The RIFLE and AKIN classifications for acute kidney injury: a critical and comprehensive review. Clin Kidney J. 2013;6:8–14. DOI:10.1093/ckj/sfs160.
18. Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007;71:1028–35. DOI:10.1038/sj.ki.5002231.
19. World Health Organization. Severe malaria. Trop Med Int Health. 2014;19 Suppl 1.:7–131. DOI: 10.1111/tmi.12313_2.
20. Schwartz GJ, Work DF. Measurement and estimation of GFR in children and adolescents. Clin J Am Soc Nephrol. 2009;4:1832–43. DOI:10.2215/CJN.01640309.
21. Jallow M, Casals-Pascual C, Ackerman H, Walther B, Walther M, Pinder M, et al. Clinical features of severe malaria associated with death: a 13-year observational study in the Gambia. PLoS One. 2012;7:e45645. DOI:10.1371/journal.pone.0045645.s001.
22. Dondorp AM, Fanello CI, Hendriksen IC, Gomes E, Seni A, Chhaganlal KD, et al. Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial. Lancet. 2010;376:1647–57. DOI:10.1016/S0140-6736(10)61924-1.
23. Prasad R, Mishra OP. Acute kidney injury in children with Plasmodium falciparum malaria: determinant for mortality. Perit Dial Int. 2016;36:213-217. DOI:10.3747/pdi.2014.00254.
24. Muhamedhussein MS, Ghosh S, Khanbhai K, Maganga E, Nagri Z, Manji M. Prevalence and factors associated with acute kidney injury among malaria patients in Dar es Salaam: a cross-sectional study. Malar Res Treat. 2019;2019:4396108. DOI:10.1155/2019/4396108.
25. Elphinstone RE, Conroy AL, Hawkes M, Hermann L, Namasopo S, Warren HS, et al. Alterations in systemic extracellular heme and hemopexin are associated with adverse clinical outcomes in Ugandan children with severe malaria. J Infect Dis. 2016;214:1268–75. DOI: 10.1093/infdis/jiw357.
26. Brand NR, Opoka RO, Hamre KES, John CC. Differing causes of lactic acidosis and deep breathing in cerebral malaria and severe malarial anemia may explain differences in acidosis-related mortality. PLoS One. 2016;11:e0163728. DOI: 10.1371/journal.pone.0163728.
Published
2022-02-15
How to Cite
1.
Afolayan F, Adedoyin O, Abdulkadir M, Ibrahim O, Biliaminu S, Mokuolu O, Ojuawo A. Incidence and predictors of acute kidney injury in children with severe malaria. PI [Internet]. 15Feb.2022 [cited 16Jun.2024];62(1):44-0. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2532
Section
Pediatric Nephrology
Received 2020-11-13
Accepted 2022-02-15
Published 2022-02-15