Prevalence, severity and clinical characteristics of acute kidney injury among children with severe malaria at Mulago Hospital.

Abstract

Background: There were 219 million malaria cases reported in 2010, and 660,000 deaths of which 91% were in Sub Saharan Africa. Disordered renal physiology in patients with severe malaria is associated with 45% mortality. There is limited data on occurrence of acute kidney injury among children with malaria. In addition, the case definition for acute kidney injury has varied in previous studies. This study described the prevalence, clinical characteristics and severity of acute kidney injury among children with severe malaria in a resource limited setting. Study objectives: The study objectives were to determine the prevalence of acute kidney injury among children with severe malaria at Mulago using the pRIFLE criteria, describe their clinical characteristics, describe the severity of acute kidney injury in these children admitted in Mulago. Methodology:This was a cohort study done at Mulago Hospital acute care unit. Children aged 6 months to 12 years with severe malaria were recruited between March 2013 and June 2013. Blood was drawn for serum creatinine levels to determine the prevalence and severity of acute kidney injury according to the pRIFLE criteria. Clinical assessment and serum creatinine were repeated until seven days since admission. Data was collected on semi-structured questionnaires. Results: The prevalence of acute kidney injury in the study was 19.9%.. According to the pRIFLE criteria, 74% fulfilled pRIFLE risk, 14% fulfilled injury, 12% fulfilled failure criteria. Of the clinical characteristics, all children with cerebral malaria and shock had acute kidney injury. Within seven days, 76.3% of those fulfilling pRIFLE-risk no longer fulfilled the RIFLE criteria, and 57.1% in those having pRIFLE-injury no longer fulfilled pRIFLE, while all in the failure group still fulfilled pRIFLE. Conclusion: One in five children with severe malaria has acute kidney injury, with most fulfilling the pRIFLE-risk criteria. A child with cerebral malaria, or with shock, must be managed with a high index of suspicion for acute kidney injury. A child with more severe forms of AKI ( pRIFLE-Failure) may not show improvement within seven days. Recommendations: The use of pRIFLE criteria in the management of children with acute kidney injury and severe malaria is recommended in our setting to decrease the morbidity and mortality due to malaria. A follow up study beyond seven days is recommended to determine the long term outcomes of acute kidney injury, like chronic kidney disease.