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Acute Kidney Injury Is Common in Pediatric Severe Malaria and Is Associated With
Increased Mortality
#MMPMID27186577
Conroy AL
; Hawkes M
; Elphinstone RE
; Morgan C
; Hermann L
; Barker KR
; Namasopo S
; Opoka RO
; John CC
; Liles WC
; Kain KC
Open Forum Infect Dis
2016[Mar]; 3
(2
): ofw046
PMID27186577
show ga
Background. ?Acute kidney injury (AKI) is a well recognized complication of
severe malaria in adults, but the incidence and clinical importance of AKI in
pediatric severe malaria (SM) is not well documented. Methods. ?One hundred
eighty children aged 1 to 10 years with SM were enrolled between 2011 and 2013 in
Uganda. Kidney function was monitored daily for 4 days using serum creatinine
(Cr). Acute kidney injury was defined using the Kidney Disease: Improving Global
Outcomes (KDIGO) guidelines. Blood urea nitrogen (BUN) and Cr were assessed using
i-STAT, and cystatin C (CysC) was measured by enzyme-linked immunosorbent assay.
Results. ?Eighty-one (45.5%) children had KDIGO-defined AKI in the study: 42
(51.9%) stage 1, 18 (22.2%) stage 2, and 21 (25.9%) stage 3. Acute kidney injury
evolved or developed in 50% of children after admission of hospital. There was an
increased risk of AKI in children randomized to inhaled nitric oxide (iNO), with
47 (54.0%) of children in the iNO arm developing AKI compared with 34 (37.4%) in
the placebo arm (relative risk, 1.36; 95% confidence interval [CI], 1.03-1.80).
Duration of hospitalization increased across stages of AKI (P = .002). Acute
kidney injury was associated with neurodisability at discharge in the children
receiving placebo (25% in children with AKI vs 1.9% in children with no AKI, P =
.002). Mortality increased across stages of AKI (P = .006) in the placebo arm,
reaching 37.5% in stage 3 AKI. Acute kidney injury was not associated with
neurodisability or mortality at discharge in children receiving iNO (P > .05 for
both). Levels of kidney biomarkers were predictive of mortality with areas under
the curves (AUCs) of 0.80 (95% CI, .65-.95; P = .006) and 0.72 (95% CI, .57-.87;
P < .001), respectively. Admission levels of CysC and BUN were elevated in
children who died by 6 months (P < .0001 and P = .009, respectively).
Conclusions. ?Acute kidney injury is an underrecognized complication in young
children with SM and is associated with increased mortality.
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