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Silent Threat : Malaria’s effect on Kidney health

Malaria, a prevalent endemic disease worldwide, continues to be a significant public health concern, particularly in tropical regions like India. According to the World Health Organization (WHO), India contributes to 83% of malaria cases in Southeast Asia as of 2021. (1) Malaria is a potentially fatal vector-borne disease caused by the Plasmodium parasite and among the four species (P. falciparumP. vivaxP. ovale , and P. malariae), two species, Plasmodium vivax, Plasmodium falciparum are commonly reported from India. The cruelty levels of this disease differ and can lead to serious complications, including kidney disease.

Understanding Malaria’s Intricacies

The infection begins with the introduction of infective sporozoites into the human body by Anopheles mosquitoes. Subsequently, the Plasmodium parasites invade red blood cells, causing their rupture and initiating a cascade of symptoms.

Different Forms of Malaria with symptoms:

Acute Malaria:

  • Symptoms include fever, accompanied by chills, rigor, anemia, and hepatosplenomegaly (enlarged liver and spleen).

Fulminant Malaria:

  • Usually caused by P. falciparum, leading to severe symptoms.
  • Manifestations include anemia, weakness (adynamia), diarrhea, jaundice, acute kidney injury, electrolyte imbalances, respiratory distress, disseminated intravascular coagulation, shock, and coma.

Chronic Malaria:

  • Persistance of malaria infection in body leads to chronicity. It is usually present with weakness, anemia and hepatosplenomegaly .
  • It can be associated some glomerulonephritis.

The Impact on Kidneys: Unveiling the Dangers

Kidney complications are frequently observed in infections by Plasmodium falciparum and Plasmodium malariae. There have also been documented cases of kidney involvement in Plasmodium vivax infections. Renal complications in P. vivax infections are linked to factors like age, hemodynamic disturbances, and respiratory failure.

The disease can affect glomeruli, tubules, and the interstitial region, leading to conditions like malarial nephropathy, electrolyte imbalances, and hemoglobinuric acute kidney injury.

Causes of Kidney Complications:

Hemodynamic dysfunction and immune responses are primary contributors to kidney complications in malaria. Liver-related issues like hepatomegaly, jaundice, and hepatic dysfunction can exacerbate the risk of acute kidney injury (AKI).

Types of Kidney Diseases in Malaria:

Histologic studies have revealed conditions such as glomerulonephritis, acute tubular necrosis, and interstitial nephritis in malaria-associated kidney disease. Chronic kidney disease may also develop, especially in patients with repeated malaria episodes.

  • Malarial Nephropathy: Malarial nephropathy can result from the deposition of parasite antigens, immune complex formation, and inflammatory responses within the kidney tissue. This condition is characterized by glomerular and tubular dysfunction, proteinuria (protein in the urine), hematuria (blood in the urine), and sometimes nephrotic syndrome.
  • Electrolyte Imbalance: Malaria-induced kidney dysfunction can disrupt the normal balance of electrolytes in the body, such as sodium, potassium, and chloride. Electrolyte imbalances can contribute to complications such as muscle weakness, cardiac arrhythmias, and metabolic acidosis.
  • Hemolysis: In severe cases of malaria, particularly with Plasmodium falciparum infection, the destruction of red blood cells (hemolysis) can occur. Hemolysis releases hemoglobin into the bloodstream, which can lead to hemoglobinuria (hemoglobin in the urine) and subsequent kidney injury, known as hemoglobinuria acute kidney injury.
  • Systemic Inflammation: Malaria triggers a systemic inflammatory response as the body attempts to fight off the infection. Excessive inflammation can contribute to kidney damage by promoting oxidative stress, endothelial dysfunction, and tissue injury within the kidneys.
  • Fluid Imbalance: Severe malaria can cause fluid shifts within the body, leading to dehydration or fluid overload. Both dehydration and fluid overload can impact kidney function and exacerbate kidney injury.

Complications of kidney disease and Mortality:

Acute kidney injury (AKI) is a well-documented consequence of severe malaria, affecting approximately 40% of individuals with severe manifestations, especially those afflicted with Plasmodium falciparum in areas where the disease is endemic. The presence of AKI substantially amplifies the risk of mortality, with rates soaring to approximately 75% in severe cases.(2)

Tips for Kidney Safety During Malaria:

  • Only take medications prescribed by a doctor.
  • Stay well-hydrated if you have a fever and undergo testing to identify the fever’s cause promptly, as addressing the root cause can prevent complications.

Discover the top 5 strategies to stay hydrated by clicking on the image below!

5 Simple Ways to Beat Dehydration This Summer
  • Begin malaria treatment immediately upon diagnosis under your doctor’s supervision.
  • If symptoms indicate severe or complicated malaria, your doctor may recommend hospital admission for intravenous medications, fluids, and supportive care to prevent life-threatening situations.
  • Avoid alternative therapies and potent painkillers during fever or established malaria, as they can potentially harm your kidneys.

Treatment for Malaria-Associated Kidney Disease:

  • Treatment involves appropriate antimalarial drugs and addressing any electrolytic disturbances, fluid replacement, and dialysis as needed for acute kidney injury (AKI).
  • Chloroquine is preferred for uncomplicated malaria treatment, though resistance exists, especially in Plasmodium falciparum infections, necessitating additional drugs like ACT (Artemisinin-based combination therapy).
  • Renal transplant patients on cyclosporine require higher doses of antimalarials due to drug interactions.
  • Consider renal replacement therapy (dialysis) for AKI treatment, with hemodialysis being more efficacious.
  • Ongoing vaccine development may reduce this burden and associated renal complications in the future.

Conclusion:

In the realm of malaria’s dangers, proper treatment is paramount to prevent life-threatening scenarios. This mosquito-borne disease, driven by Plasmodium parasites, manifests in recurrent chills and fever, impacting vital organs profoundly.

Our kidneys, pivotal in this health narrative, face malaria’s complexities. Through adherence to medical advice, caution against unverified remedies, and timely interventions, we fortify our kidneys against malaria’s impacts.

With vaccines on the horizon, we envision a future where malaria’s toll on organs diminishes, fostering healthier communities globally. Let’s unite in vigilance and informed action for a malaria-free tomorrow.

References:

  1. https://www.who.int/india/health-topics/malaria/summary-of-world-malaria-report-2021#:~:text=India%20being%20the%20largest%20contributor,WHO%20South%2DEast%20Asia%20Region.
  2. https://malariajournal.biomedcentral.com/articles/10.1186/s12936-015-1057-9#:~:text=In%20malaria%2Dendemic%20regions%2C%20AKI,immune%20travellers%20with%20severe%20P.

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Dr Pratim Sengupta's Team (Nephro)
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