Acute kidney injury due to acute cortical necrosis following vivax malaria
Malaria is a parasitic infection of global importance but has a high prevalence in the developing countries. Renal failure is a common complication of severe Plasmodium falciparum malaria and has been reported in up to 40% of all cases. Acute kidney injury (AKI), however, is not commonly associated...
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Published in | Saudi journal of kidney diseases and transplantation Vol. 30; no. 4; pp. 960 - 963 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
Riyadh, Saudi Arabia
Saudi Center for Organ Transplantation
01.07.2019
Wolters Kluwer India Pvt. Ltd Medknow Publications and Media Pvt. Ltd Medknow Publications & Media Pvt. Ltd Wolters Kluwer Medknow Publications |
Subjects | |
Online Access | Get full text |
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Summary: | Malaria is a parasitic infection of global importance but has a high prevalence in
the developing countries. Renal failure is a common complication of severe Plasmodium
falciparum malaria and has been reported in up to 40% of all cases. Acute kidney injury (AKI),
however, is not commonly associated with Plasmodium vivax infection. In those patients who
develop AKI following P. vivax infection, the cause is commonly attributed to mixed
undiagnosed falciparum infection or coexistent sepsis, dehydration, or hypotension. Infrequently,
an association of P. vivax infection with thrombotic microangiopathy (TMA) has been reported.
The purpose of this report is to describe renal failure due to TMA following malaria caused by P.
vivax. A 24-year-old female presented with a history of fever and jaundice of two weeks duration
followed by progressive oliguria and swelling of the face and feet five days after the onset of
fever. The evaluation revealed normal blood pressure, anemia, thrombocytopenia, azotemia,
unconjugated hyperbilirubinemia with mildly elevated transaminases, and elevated lactate
dehydrogenase. Peripheral smear was positive for P. vivax, and schistocytes were seen. She was
given intravenous artesunate followed by oral primaquine for 14 days. Urine examination showed
proteinuria and microscopic hematuria. She remained oliguric and dialysis dependent, and her
kidney biopsy revealed patchy cortical necrosis involving 40% of sampled cortex with
widespread fibrinoid necrosis of the vessel wall, red blood cell fragmentation, and luminal
thrombotic occlusion. Hemodialysis was discontinued after three weeks when there was the
improvement of renal function over time, and her serum creatinine decreased to 2.2 mg/dL by six
weeks. Patients with P. vivax malaria developing renal failure may have TMA. Renal biopsy, if
performed early in the course of the disease, may identify TMA and institution of plasma
exchange in such patients could help in early recovery. |
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ISSN: | 1319-2442 2320-3838 |
DOI: | 10.4103/1319-2442.265474 |