12^th Global Nephrologists Annual Meeting

Biography

Biography: Kallol Bhattacharjee

Abstract

Approximately 40% of world’s population lives in areas where malaria is endemic mainly in tropical and sub tropical regions. World Health Organization (WHO) estimated a staggering figure of 214 million new cases of malaria in 2015 with an estimated death of 438,000 worldwide, majority of which occurred in African countries. Acute kidney injury (AKI) is fairly common, and serious complications are seen in acute falciparum malaria in adults. Malaria associated kidney disease (MAKI) is defined as “An abrupt decline in renal function in a patient who is suffering from acute malaria within 48 hours of onset characterized by an elevation of serum creatinine >0.3 mg/dl or elevation of creatinine level by >50% and/or oliguria with urine output <0.5 ml/kg/hr in >6 hours.” Incidence of AKI varies from 0.4-60% and is due to the variation in age, immunity status and locality. Complications are caused by interaction of the parasite with the host resulting in mechanical, immunological and humoral responses. MAKI is a result of combinations of two processes - cytoadherance and cytokines. Parasite containing RBCs express a protein called ‘variant surface antigen’ (VSA) on their surface. These RBCs attach to vascular endothelium using VSA and sequestration of the same into glomerular and tubulo-interstitial capillaries may cause AKI. Cytokines cause an increase in nitric oxide in the vessels or facilitate mitochondrial shutdown thereby leading to generalized arterial vasodilatation, increased permeability, increased interstitial volume, renal vasoconstriction with retention of Na⁺ and H₂O, tissue hypoxia and thereby leading to glomerular injury. The vulnerable groups of patient include the pregnant women, high parasitemia, jaundice, prolonged dehydration and those on NSAID therapy. Two subsets of population – AKI occurring as a component of multi organ dysfunction (MOD) or AKI as a sole complication of malaria appearing at a later stage when other components have subsided or treated or did not appear. The later bears a better prognosis. Urine output is usually <400 ml/day and may persist for 3-10 days. Cerebral malaria is associated with AKI in 30% of cases and worsens the prognosis. MAKI usually resolves in days to weeks, do not progress to chronic kidney disease (CKD) or acute tubular necrosis (ATN) and mortality ranges from 15 to 50%. Anti-malarials, fluid management, treatment and prevention of complications and dialysis are the mainstay of treatment. Early initiation of dialysis has proven mortality benefit.