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Acidosis and acute kidney injury in severe malaria
#MMPMID29566677
Sriboonvorakul N
; Ghose A
; Hassan MMU
; Hossain MA
; Faiz MA
; Pukrittayakamee S
; Chotivanich K
; Sukthana Y
; Leopold SJ
; Plewes K
; Day NPJ
; White NJ
; Tarning J
; Dondorp AM
Malar J
2018[Mar]; 17
(1
): 128
PMID29566677
show ga
BACKGROUND: In severe falciparum malaria metabolic acidosis and acute kidney
injury (AKI) are independent predictors of a fatal outcome in all age groups. The
relationship between plasma acids, urine acids and renal function was
investigated in adult patients with acute falciparum malaria. METHODS: Plasma and
urinary acids which previously showed increased concentrations in proportion to
disease severity in patients with severe falciparum malaria were quantified.
Patients with uncomplicated malaria, sepsis and healthy volunteers served as
comparator groups. Multiple regression and multivariate analysis were used to
assess the relationship between organic acid concentrations and clinical
syndromes, in particular AKI. RESULTS: Patients with severe malaria (n?=?90),
uncomplicated malaria (n?=?94), non-malaria sepsis (n?=?19), and healthy
volunteers (n?=?61) were included. Univariate analysis showed that both plasma
and creatinine-adjusted urine concentrations of p-hydroxyphenyllactic acid
(pHPLA) were higher in severe malaria patients with AKI (p?0.001). Multiple
regression analysis, including plasma or creatinine-adjusted urinary acids, and
PfHRP2 as parasite biomass marker as independent variables, showed that pHPLA was
independently associated with plasma creatinine (??=?0.827) and urine creatinine
(??=?0.226). Principal component analysis, including four plasma acids and seven
urinary acids separated a group of patients with AKI, which was mainly driven by
pHPLA concentrations. CONCLUSIONS: Both plasma and urine concentrations of pHPLA
closely correlate with AKI in patients with severe falciparum malaria. Further
studies will need to assess the potential nephrotoxic properties of pHPLA.