Plasmodium vivax malaria complicated by acute kidney injury: experience at a referral hospital in Uttarakhand, India

Abstract

Acute kidney injury (AKI) is a serious complication of Plasmodium vivax malaria, worsening its prognosis. This prospective study assessed the incidence, clinical spectrum, prognostic factors and outcome of AKI in P. vivax malaria. During 2010-2011, 195 patients with vivax malaria diagnosed by positive peripheral blood film and rapid malaria test were studied for AKI using RIFLE criteria. AKI occurred in 63 patients (32%), with maximum RIFLE class R (Risk), class I (Injury) and class F (Failure) in 27 (43%), 23 (37%) and 13 (21%) patients, respectively. AKI was associated with oliguria/anuria (48%), anaemia (70%), thrombocytopenia (84%), hepatic dysfunction (48%), gastrointestinal manifestations (33%), acute respiratory distress syndrome (ARDS) (14%), cerebral malaria (6%), disseminated intravascular coagulation (8%) and shock (11%). All 63 patients with AKI received artesunate and 12 (19%) received quinine after failure of response to artesunate. Fourteen patients (22%) underwent haemodialysis. Patients with maximum RIFLE class R, I and F had mortality rates of 3.7%, 4.3% and 30.7%, respectively. Poor prognostic factors were delayed diagnosis, anaemia, severe AKI, shock, ARDS, need for ventilatory support, raised serum transaminases and metabolic acidosis. AKI is now common in vivax malaria and has significant mortality. Its early recognition and management can improve the outcome.