Abstract
BackgroundUtility of sonographic assessments of renal changes during malaria illness are rarely reported in African children in spite of the high burden of malarial-related kidney damage.MethodsIn this case–control study, renal sizes, cortical thickness and volume of the kidneys of 131 healthy children and 170 with acute falciparum malaria comprising 85 uncomplicated malaria (UM) and 85 complicated malaria (CM) cases, measured within 24 hours of presenting in the hospital were compared.ResultsThe mean age of children with UM, CM and control groups was 49.7 ± 26.2 months, 50.7 ± 29.3 months and 73.4 ± 25.5 months, respectively (p < 0.001). The mean right kidney length of CM group was higher than control by 0.41cm (95% CI = 0.16, 0.65; p < 0.001) and UM by 0.32 cm (95% CI = 0.02, 0.62; p = 0.030). Similarly, mean left kidney length of CM was higher than control and UM by 0.34 cm (95% CI = 0.09, 0.60; p = 0.005) and 0.41cm (95% CI = 0.09, 0.72; p = 0.006), respectively. Estimated mean renal volume of the CM group was significantly higher than control group by 7.82 cm3 for right and by 5.79 cm3 for left kidneys respectively; in the UM group by 9.31cm3 for right and 8.87 cm3 for left kidneys respectively.ConclusionThere was a marginal increase in renal size of children with Plasmodium falciparum infection, which worsened with increasing severity of malaria morbidity. Ultrasonography provides important information for detecting renal changes in children with acute malaria.
Highlights
Utility of sonographic assessments of renal changes during malaria illness are rarely reported in African children in spite of the high burden of malarial-related kidney damage
About 90% of the reported cases and 85% of the deaths have been attributed to malaria in sub-Saharan Africa [3], where Plasmodium falciparum infection is responsible for almost all the morbidity and mortality
The pathophysiology of severe falciparum malaria is complex and multifactorial with parasitized red blood cell destruction resulting in the release of haemoglobin and other toxic metabolites, up-regulation of cytokines, acute phase reactants all playing important pathogenic roles which may cause inflammation, tubulo-interstitial damage, glomerulonephritis and pigment nephropathy, all of which may lead to acute kidney injury (AKI) [4]
Summary
Utility of sonographic assessments of renal changes during malaria illness are rarely reported in African children in spite of the high burden of malarial-related kidney damage. About 90% of the reported cases and 85% of the deaths have been attributed to malaria in sub-Saharan Africa [3], where Plasmodium falciparum infection is responsible for almost all the morbidity and mortality. Data from Ghana [7] and Kenya [8] indicated that signs of shock, such as capillary refill, are common in children suffering from severe malaria. These adverse effects, though secondary rather than primary, support potential reversible ischaemic damage to the kidneys during acute malarial illness. Repeated P. falciparum infections can result in nephron loss leading to chronic renal disease, including nephrotic syndrome, often non-responsive to steroid treatment [9,10,11,12]
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