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Xavier AM, Kumar AS. Acute kidney injury in the tropics. Trop Doct 2024; 54:98-107. [PMID: 38247316 DOI: 10.1177/00494755231222956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Acute kidney injury in the Tropics is strikingly different from that in developed countries in terms of aetiology and presentation. Moreover, there are radical differences between the developed world and the economically poorer regions within the tropics. Infections are the number one cause leading to significant mortality. This article reviews the most common causes of acute kidney injury in the Tropics and describes its management briefly.
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Affiliation(s)
- Asha Maria Xavier
- Assistant Professor, Department of Internal Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
| | - Ag Sravan Kumar
- Assistant Professor, Department of Orthopaedics, Shri Sathya Sai Medical College and Research Institute, Chengalpet, Tamil Nadu, India
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Ramos S, Jeney V, Figueiredo A, Paixão T, Sambo MR, Quinhentos V, Martins R, Gouveia Z, Carlos AR, Ferreira A, Pais TF, Lainé H, Faísca P, Rebelo S, Cardoso S, Tolosano E, Penha-Gonçalves C, Soares MP. Targeting circulating labile heme as a defense strategy against malaria. Life Sci Alliance 2024; 7:e202302276. [PMID: 38307624 PMCID: PMC10837040 DOI: 10.26508/lsa.202302276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/04/2024] Open
Abstract
Severe presentations of malaria emerge as Plasmodium (P.) spp. parasites invade and lyse red blood cells (RBC), producing extracellular hemoglobin (HB), from which labile heme is released. Here, we tested whether scavenging of extracellular HB and/or labile heme, by haptoglobin (HP) and/or hemopexin (HPX), respectively, counter the pathogenesis of severe presentations of malaria. We found that circulating labile heme is an independent risk factor for cerebral and non-cerebral presentations of severe P. falciparum malaria in children. Labile heme was negatively correlated with circulating HP and HPX, which were, however, not risk factors for severe P. falciparum malaria. Genetic Hp and/or Hpx deletion in mice led to labile heme accumulation in plasma and kidneys, upon Plasmodium infection This was associated with higher incidence of mortality and acute kidney injury (AKI) in ageing but not adult Plasmodium-infected mice, and was corroborated by an inverse correlation between heme and HPX with serological markers of AKI in P. falciparum malaria. In conclusion, HP and HPX act in an age-dependent manner to prevent the pathogenesis of severe presentation of malaria in mice and presumably in humans.
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Affiliation(s)
- Susana Ramos
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Viktoria Jeney
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Ana Figueiredo
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Tiago Paixão
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Maria Rosário Sambo
- Hospital Pediátrico David Bernardino, Luanda, Angola
- Faculdade de Medicina, Universidade Agostinho Neto, Luanda, Angola
| | - Vatúsia Quinhentos
- Hospital Pediátrico David Bernardino, Luanda, Angola
- Faculdade de Medicina, Universidade Agostinho Neto, Luanda, Angola
| | - Rui Martins
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Zélia Gouveia
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Ana Rita Carlos
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Ana Ferreira
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Teresa F Pais
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Hugo Lainé
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Pedro Faísca
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Sofia Rebelo
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Silvia Cardoso
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Emanuela Tolosano
- Department Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | | | - Miguel P Soares
- https://ror.org/04b08hq31 Instituto Gulbenkian de Ciência, Oeiras, Portugal
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Freidin N, Hayes E, Struthers SA. Implications of climate change on acute kidney injury. Curr Opin Nephrol Hypertens 2024; 33:83-88. [PMID: 37678384 DOI: 10.1097/mnh.0000000000000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE OF REVIEW Climate change is an active and growing threat to human health. This review examines the evidence linking climate change to kidney diseases, with a focus on acute kidney injury (AKI). RECENT FINDINGS A growing body of evidence documents the adverse impact of various environmental and occupational exposures on kidney health. Extreme heat exposure increases the risk for AKI in vulnerable populations, particularly outdoor workers. These effects are being seen in both developed and developing nations, impacting equatorial as well as more northern climates. Climate change is also increasing the risk of water-borne and vector-borne infections, which are important causes of AKI in tropical regions. Due to overlapping environmental and social risk factors, populations in low-income and middle-income countries are likely to be disproportionately affected by climate-related health impacts, including heightened risk for kidney diseases. SUMMARY Climate change will adversely impact global kidney health over the course of the century through effects on temperature and risk of endemic infections. Alongside efforts to aggressively reduce carbon emissions, additional research is needed to guide public and environmental health policies aimed at mitigating the impact of climate change on human health.
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Affiliation(s)
- Natalie Freidin
- Medical University of South Carolina, Charleston, South Carolina
| | - Eily Hayes
- Medical University of South Carolina, Charleston, South Carolina
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Mwaba C, Munsaka S, Bvulani B, Mwakazanga D, Chiluba BC, Fitzwanga K, Mpabalwani E. Malaria is the leading cause of acute kidney injury among a Zambian paediatric renal service cohort retrospectively evaluated for aetiologies, predictors of the need for dialysis, and outcomes. PLoS One 2023; 18:e0293037. [PMID: 37878602 PMCID: PMC10599569 DOI: 10.1371/journal.pone.0293037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/03/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Whilst malaria is a prominent aetiology associated with acute kidney injury (AKI) in many parts of Africa, a shift in the traditional AKI aetiologies has been witnessed in sections of the continent. Additionally, limited access to dialysis worsens patient outcomes in these low-resource settings. This retrospective cross-sectional study aimed to determine the associated aetiologies, predictors of need for dialysis and malaria-associated AKI (MAKI), and outcomes of AKI and dialysis among children evaluated by the renal service in Lusaka, Zambia. METHODS The study sampled all children aged 16 years or below, diagnosed with AKI between 2017 and 2021, by the renal unit at the University Teaching Hospitals- Children's Hospital (UTH-CH), and retrospectively abstracted their records for exposures and outcomes. AKI was defined using the Kidney Disease Improving Global Outcomes (KDIGO) 2012 criteria. Frequency and percentage distributions were used to describe the occurrence of AKI aetiologies and treatment outcomes. Predictors of the need for dialysis, MAKI, and poor treatment outcome were identified by using multivariable logistic regression models. RESULTS A total of 126 children diagnosed with AKI were included in this study. Malaria was the most frequent aetiology of AKI(61.1% (77/126, 95% Confidence Interval (CI): 52.0%-69.7%)). Of the 126 children with AKI, 74.6% (94) underwent dialysis. Predictors of the need for dialysis were oliguria (p = 0.0024; Odds ratio (OR) = 7.5, 95% CI: 2.1-27.7) and anuria (p = 0.0211; OR = 6.4, 95% CI = 1.3, 30.7). A fifth (18.3%, 23/126) of the children developed chronic kidney disease (CKD), 5.6% (7/126) died and, a year later, 77% (97/126) were lost to follow-up. CONCLUSION At UTH-CH, malaria is the most frequent aetiology among children with AKI undergoing dialysis and children from low-medium malaria incidence areas are at risk; a considerable proportion of children with AKI need dialysis and Tenchoff catheter use in AKI is advocated.
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Affiliation(s)
- Chisambo Mwaba
- Department of Paediatrics and Child Health, School of Medicine, University of Zambia, Lusaka, Zambia
- Department of Paediatrics, University Teaching Hospitals-Children’s Hospital, Lusaka, Zambia
| | - Sody Munsaka
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Bruce Bvulani
- Department of Paediatric Surgery, University Teaching Hospitals-Adult Hospital, Lusaka, Zambia
| | - David Mwakazanga
- Department of Public Health, Tropical Diseases Research Centre, 6-7 Floors Ndola Teaching Hospital, Ndola, Zambia
| | - Brian Chanda Chiluba
- Department of Biostatistics and Epidemiology, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Kaiser Fitzwanga
- Department of Paediatrics, Intensive Care Unit, Windhoek Central Hospital, Windhoek, Namibia
| | - Evans Mpabalwani
- Department of Paediatrics and Child Health, School of Medicine, University of Zambia, Lusaka, Zambia
- Department of Paediatrics, University Teaching Hospitals-Children’s Hospital, Lusaka, Zambia
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Abstract
The burden of cardiovascular diseases is sharply rising in low- and middle-income countries (LMICs). Along with the increasing rates of cardiovascular risk factors in these regions, there is a growing recognition of the contribution of neglected tropical diseases and other infections. Several cardiac implications of these infections have been reported but have not yet been validated by robust population data. This is in part due to limited access to health care and insufficient data collection infrastructure in many LMICs. Therefore, the true impact of these infections on the cardiovascular system may be underestimated, because of both underdiagnosis and underreporting bias. There is an urgent need to thoroughly delineate the cardiac impact of these conditions with elevated prevalence in LMICs and to propose strategies to reduce the negative consequences of these diseases in health systems with limited resources.
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Wu Q, Sacomboio E, Valente de Souza L, Martins R, Kitoko J, Cardoso S, Ademolue TW, Paixão T, Lehtimäki J, Figueiredo A, Norden C, Tharaux PL, Weiss G, Wang F, Ramos S, Soares MP. Renal control of life-threatening malarial anemia. Cell Rep 2023; 42:112057. [PMID: 36735532 DOI: 10.1016/j.celrep.2023.112057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/30/2022] [Accepted: 01/17/2023] [Indexed: 02/04/2023] Open
Abstract
Iron recycling prevents the development of anemia under homeostatic conditions. Whether iron recycling was co-opted as a defense strategy to prevent the development of anemia in response to infection is unclear. We find that in severe Plasmodium falciparum malaria, the onset of life-threatening anemia is associated with acute kidney injury (AKI), irrespective of parasite load. Using a well-established experimental rodent model of malaria anemia, we identify a transcriptional response that endows renal proximal tubule epithelial cells (RPTECs) with the capacity to store and recycle iron during P. chabaudi chabaudi (Pcc) infection. This response encompasses the induction of ferroportin 1/SLC40A1, which exports iron from RPTECs and counteracts AKI while supporting compensatory erythropoiesis and preventing the onset of life-threatening malarial anemia. Iron recycling by myeloid cells is dispensable to this protective response, suggesting that RPTECs provide an iron-recycling salvage pathway that prevents the pathogenesis of life-threatening malarial anemia.
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Affiliation(s)
- Qian Wu
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | | | - Lara Valente de Souza
- Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria; Christian Doppler Laboratory for Iron Metabolism and Anemia Research, Medical University of Innsbruck, Innsbruck, Austria
| | - Rui Martins
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Jamil Kitoko
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | | | | | - Tiago Paixão
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | | | | | - Caren Norden
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Pierre-Louis Tharaux
- Paris Cardiovascular Center (PARCC), Institut National de la Santé et de la Recherche Médicale (Inserm), Université Paris Cité, Paris, France
| | - Guenter Weiss
- Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria; Christian Doppler Laboratory for Iron Metabolism and Anemia Research, Medical University of Innsbruck, Innsbruck, Austria
| | - Fudi Wang
- The First Affiliated Hospital, Institute of Translational Medicine, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Susana Ramos
- Instituto Gulbenkian de Ciência, Oeiras, Portugal.
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Omar FD, Phumratanaprapin W, Silachamroon U, Hanboonkunupakarn B, Sriboonvorakul N, Thaipadungpanit J, Pan-ngum W. Clinical Characteristics of Acute Kidney Injury Associated with Tropical Acute Febrile Illness. Trop Med Infect Dis 2023; 8:tropicalmed8030147. [PMID: 36977148 PMCID: PMC10056292 DOI: 10.3390/tropicalmed8030147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
Tropical acute febrile illness (TAFI) is one of the most frequent causes of acute kidney injury (AKI). The prevalence of AKI varies worldwide because there are limited reports available and different definitions are used. This retrospective study aimed to determine the prevalence, clinical characteristics, and outcomes of AKI associated with TAFI among patients. Patients with TAFI were classified into non-AKI and AKI cases based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Of 1019 patients with TAFI, 69 cases were classified as having AKI, a prevalence of 6.8%. Signs, symptoms, and laboratory results were significantly abnormal in the AKI group, including high-grade fever, dyspnea, leukocytosis, severe transaminitis, hypoalbuminemia, metabolic acidosis, and proteinuria. 20.3% of AKI cases required dialysis and 18.8% received inotropic drugs. Seven patients died, all of which were in the AKI group. Risk factors for TAFI-associated AKI were being male (adjusted odds ratio (AOR) 3.1; 95% CI 1.3–7.4), respiratory failure (AOR 4.6 95% CI 1.5–14.1), hyperbilirubinemia (AOR 2.4; 95% CI 1.1–4.9), and obesity (AOR 2.9; 95% CI 1.4–6). We recommend clinicians investigate kidney function in patients with TAFI who have these risk factors to detect AKI in its early stages and offer appropriate management.
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Affiliation(s)
- Fardosa Dahir Omar
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu 2526, Somalia
| | - Weerapong Phumratanaprapin
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Correspondence: ; Tel.: +662-354-9168
| | - Udomsak Silachamroon
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Borimas Hanboonkunupakarn
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Mahidol-Oxford Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Natthida Sriboonvorakul
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Janjira Thaipadungpanit
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Mahidol-Oxford Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Wirichada Pan-ngum
- Mahidol-Oxford Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
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Prema J, Kurien AA. Hemoglobin Casts in Kidney Biopsies: Etiological Spectrum. Indian J Nephrol 2023; 33:46-49. [PMID: 37197049 PMCID: PMC10185015 DOI: 10.4103/ijn.ijn_454_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/17/2021] [Accepted: 01/09/2022] [Indexed: 05/19/2023] Open
Abstract
Intravascular hemolysis, which is the destruction of red blood cells in circulation, can cause acute kidney injury as the hemoglobin released by the lysed cells is toxic to the tubular epithelial cells. We performed a retrospective analysis of 56 cases of hemoglobin cast nephropathy reported at our institution to analyze the etiological spectrum causing this rare disease. The mean patient age was 41.7 (range: 2-72 years), and the male-to-female ratio was 1.8:1. All patients presented with acute kidney injury. The etiologies include rifampicin-induced, snake bite, autoimmune hemolytic anemia, falciparum malarial infection, leptospiral infection, autoimmune hemolytic anemia, sepsis, non-steroidal anti-inflammatory drugs, ingestion of termite oil, heavy metal poisoning, wasp sting, and valvular heart disease with severe mitral regurgitation. We demonstrate a wide spectrum of conditions associated with hemoglobin casts in the kidney biopsy. Hemoglobin immunostain is required to establish the diagnosis.
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Affiliation(s)
- Jansi Prema
- Department of Pathology, Renopath, Center for Renal and Urological Pathology, Chennai, Tamil Nadu, India
| | - Anila A Kurien
- Department of Pathology, Renopath, Center for Renal and Urological Pathology, Chennai, Tamil Nadu, India
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Possemiers H, Pollenus E, Prenen F, Knoops S, Koshy P, Van den Steen PE. Experimental malaria-associated acute kidney injury is independent of parasite sequestration and resolves upon antimalarial treatment. Front Cell Infect Microbiol 2022; 12:915792. [PMID: 36004329 PMCID: PMC9394429 DOI: 10.3389/fcimb.2022.915792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022] Open
Abstract
Malaria remains a important global disease with more than 200 million cases and 600 000 deaths each year. Malaria-associated acute kidney injury (MAKI) may occur in up to 40% of patients with severe malaria and is associated with increased mortality. Histopathological characteristics of AKI in malaria are acute tubular injury, interstitial nephritis, focal segmental glomerulosclerosis, collapsing glomerulopathy and glomerulonephritis. We observed that C57BL/6 mice infected with Plasmodium berghei NK65 (PbNK65) develop MAKI in parallel with malaria-associated acute respiratory distress syndrome (MA-ARDS). MAKI pathology was associated with proteinuria, acute tubular injury and collapse of glomerular capillary tufts, which resolved rapidly after treatment with antimalarial drugs. Importantly, parasite sequestration was not detected in the kidneys in this model. Furthermore, with the use of skeleton binding protein-1 (SBP-1) KO PbNK65 parasites, we found that parasite sequestration in other organs and its subsequent high parasite load are not required for the development of experimental MAKI. Similar proteinuria, histopathological features, and increases in kidney expression of interferon-γ, TNF-α, kidney injury molecule-1 (KIM-1) and heme oxygenase-1 (HO-1) was observed in both infected groups despite a significant difference in parasite load. Taken together, we introduce a model of experimental AKI in malaria with important similarities to AKI in malaria patients. Therefore, this mouse model might be important to further study the pathogenesis of AKI in malaria.
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Affiliation(s)
- Hendrik Possemiers
- Laboratory of Immunoparasitology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, KU, Leuven, Belgium
| | - Emilie Pollenus
- Laboratory of Immunoparasitology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, KU, Leuven, Belgium
| | - Fran Prenen
- Laboratory of Immunoparasitology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, KU, Leuven, Belgium
| | - Sofie Knoops
- Laboratory of Immunoparasitology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, KU, Leuven, Belgium
| | - Priyanka Koshy
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Philippe E. Van den Steen
- Laboratory of Immunoparasitology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, KU, Leuven, Belgium
- *Correspondence: Philippe E. Van den Steen,
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Pathophysiology of Acute Kidney Injury in Malaria and Non-Malarial Febrile Illness: A Prospective Cohort Study. Pathogens 2022; 11:pathogens11040436. [PMID: 35456111 PMCID: PMC9031196 DOI: 10.3390/pathogens11040436] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/24/2022] [Accepted: 03/31/2022] [Indexed: 01/06/2023] Open
Abstract
Acute kidney injury (AKI) is a life-threatening complication. Malaria and sepsis are leading causes of AKI in low-and-middle-income countries, but its etiology and pathogenesis are poorly understood. A prospective observational cohort study was conducted to evaluate pathways of immune and endothelial activation in children hospitalized with an acute febrile illness in Uganda. The relationship between clinical outcome and AKI, defined using the Kidney Disease: Improving Global Outcomes criteria, was investigated. The study included 967 participants (mean age 1.67 years, 44.7% female) with 687 (71.0%) positive for malaria by rapid diagnostic test and 280 (29.1%) children had a non-malarial febrile illness (NMFI). The frequency of AKI was higher in children with NMFI compared to malaria (AKI, 55.0% vs. 46.7%, p = 0.02). However, the frequency of severe AKI (stage 2 or 3 AKI) was comparable (12.1% vs. 10.5%, p = 0.45). Circulating markers of both immune and endothelial activation were associated with severe AKI. Children who had malaria and AKI had increased mortality (no AKI, 0.8% vs. AKI, 4.1%, p = 0.005), while there was no difference in mortality among children with NMFI (no AKI, 4.0% vs. AKI, 4.6%, p = 0.81). AKI is a common complication in children hospitalized with acute infections. Immune and endothelial activation appear to play central roles in the pathogenesis of AKI.
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Randrianarisoa RMF, Ranivoharisoa EM, Ahmed M, Ramilitiana B, Rakotomalala NL, Randria MJDD, Randriamarotia WFH. [Acute kidney injury and severe malaria in adults: A monocentric descriptive study in Madagascar using KDIGO criteria]. Nephrol Ther 2021; 17:434-440. [PMID: 34045125 DOI: 10.1016/j.nephro.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/19/2021] [Accepted: 03/24/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Acute Kidney Injury (AKI) is one of the criteria for severe malaria with a varied incidence. Our objectives are to determine the prevalence of malaria-associated AKI and to report the characteristics of patients with the evolution of cases. PATIENTS AND METHOD This is a 5-year retrospective descriptive study from January 1, 2015 to December 31, 2019 in the Infectious Diseases department of the University Hospital Center of Befelatanana Antananarivo. Among 379 patients diagnosed, 103 patients (27,18%) with associated AKI were included. We used the criteria of Kidney Disease Improving Global Outcomes group to define AKI. RESULTS The prevalence of AKI was 27.18%. The mean age of patients was 34.92 years and the sex-ratio was 3.68. Plasmodium falciparum was the causative agent in 98.06% of cases followed by Plasmodium vivax. Diuresis was preserved in 69.86% of cases. Jaundice was the main sign of severity associated (49.51%). The mean creatinine level was 466.93μmol/L. The evolution was favorable under antimalarial drug and rehydration. Dialysis was required in 25.24% of cases. Thirteen patients had died, a rate of 12.62%, of which 8 patients (61.54%) had dialysis criteria but had not been purged for economic reasons. CONCLUSION AKI is a frequent complication of malaria. It is responsible for significant mortality despite improved care in the fight against malaria.
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Affiliation(s)
| | | | - Mohamed Ahmed
- Service de médecine interne, centre hospitalier Joseph Raseta Befelatanana, Andrefan'Ambohijanahary, Antananarivo, Madagascar
| | - Benja Ramilitiana
- Service de néphrologie, centre hospitalier Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | | | - Mamy Jean de Dieu Randria
- Service des maladies infectieuses, centre hospitalier Joseph Raseta Befelatanana, Antananarivo, Madagascar
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Rosinger AY, Bethancourt H, Swanson ZS, Nzunza R, Saunders J, Dhanasekar S, Kenney WL, Hu K, Douglass MJ, Ndiema E, Braun DR, Pontzer H. Drinking water salinity is associated with hypertension and hyperdilute urine among Daasanach pastoralists in Northern Kenya. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 770:144667. [PMID: 33515884 PMCID: PMC7969420 DOI: 10.1016/j.scitotenv.2020.144667] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/20/2020] [Accepted: 12/15/2020] [Indexed: 05/30/2023]
Abstract
Water salinity is a growing global environmental health concern. However, little is known about the relation between water salinity and chronic health outcomes in non-coastal, lean populations. Daasanach pastoralists living in northern Kenya traditionally rely on milk, yet are experiencing socioecological changes and have expressed concerns about the saltiness of their drinking water. Therefore, this cross-sectional study conducted water quality analyses to examine how water salinity, along with lifestyle factors like milk intake, was associated with hypertension (blood pressure BP ≥140 mm Hg systolic or ≥90 mm Hg diastolic) and hyperdilute urine (urine specific gravity <1.003 g/mL, indicative of altered kidney function). We collected health biomarkers and survey data from 226 non-pregnant adults (46.9% male) aged 18+ from 134 households in 2019 along with participant observations in 2020. The salinity (total concentration of all dissolved salts) of reported drinking water from hand-dug wells in dry river beds, boreholes, and a pond ranged from 120 to 520 mg/L. Water from Lake Turkana and standpipes, which was only periodically used for consumption when no other drinking sources are available, ranged from 1100 to 2300 mg/L. Multiple logistic regression models with standard errors clustered on households indicate that each additional 100 mg/L of drinking water salinity was associated with 45% (95% CI: 1.09-1.93, P = 0.010) increased odds of hypertension and 33% (95% CI: 0.97-1.83, P = 0.075) increased odds of hyperdilute urine adjusted for confounders. Results were robust to multiple specifications of the models and sensitivity analyses. Daily milk consumption was associated with 61-63% (P < 0.01) lower odds of both outcomes. This considerable protective effect of milk intake may be due to the high potassium, magnesium, and calcium contents or the protective lifestyle considerations of moving with livestock. Our study results demonstrate that drinking water salinity may have critical health implications for blood pressure and kidney function even among lean, active pastoralists.
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Affiliation(s)
- Asher Y Rosinger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, United States of America; Department of Anthropology, Pennsylvania State University, State College, PA, United States of America.
| | - Hilary Bethancourt
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, United States of America
| | - Zane S Swanson
- Department of Evolutionary Anthropology, Duke University, Durham, NC, United States of America
| | | | - Jessica Saunders
- Department of Evolutionary Anthropology, Duke University, Durham, NC, United States of America
| | - Shiva Dhanasekar
- Department of Anthropology, Emory University, Atlanta, GA, United States of America
| | - W Larry Kenney
- Department of Kinesiology, Pennsylvania State University, University Park, PA, United States of America
| | - Kebin Hu
- Department of Medicine, Pennsylvania State University, Hershey, PA, United States of America
| | - Matthew J Douglass
- College of Agricultural Sciences and Natural Resources and Agricultural Research Division, University of Nebraska-Lincoln, Lincoln, NE, United States of America
| | - Emmanuel Ndiema
- Department of Earth Sciences, National Museums of Kenya, Nairobi, Kenya
| | - David R Braun
- Center for the Advanced Study of Human Paleobiology, Department of Anthropology, The George Washington University, Washington, DC, United States of America; Department of Human Evolution, Max Planck Institute of Evolutionary Anthropology, 04103 Leipzig, Germany
| | - Herman Pontzer
- Department of Evolutionary Anthropology, Duke University, Durham, NC, United States of America; Global Health Institute, Duke University, Durham, NC, United States of America
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13
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Naqvi R. Epidemiological trends in community acquired acute Kidney Injury in Pakistan: 25 years Experience from a Tertiary Care Renal Unit. Pak J Med Sci 2021; 37:312-319. [PMID: 33679905 PMCID: PMC7931297 DOI: 10.12669/pjms.37.2.3876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/06/2020] [Accepted: 12/25/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Epidemiological studies of community acquired acute kidney injury (AKI) are sparse especially from South Asia and none has published from Pakistan. Reported incidences from different countries vary with use of different criteria of defining AKI. There is also variation found in different class of income countries, hospital based versus community based AKI. METHODS The current study was carried out in all adult AKI patients developing community acquired AKI and coming to a tertiary care renal institution from January 1990 to December 2014. This is a retrospective data collection from patient's records and AKI was defined according to KDIGO guidelines. Trends among different groups which are classified in medical, obstetrical and surgical were observed and presented. RESULTS In medical AKI there has been found a rise in toxic rhabdomyolysis, vivax malaria and dengue infection during later part of study. In obstetrical AKI observed continuous rise in numbers contributing to total AKI during these years. Surgical AKI included obstructed cases during initial ten years and only surgical trauma during later 15 years. Older age on presentation in medical AKI, and thrombocytopenia, deranged coagulation, deranged liver function, hyperkalemia, requirement of mechanical ventilation and multi organ failure in all groups remained predictors of higher mortality. CONCLUSION From Pakistan epidemiology for community acquired AKI has never been published on a large scale and this study would remain source of great information in this regard over coming years.
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Affiliation(s)
- Rubina Naqvi
- Prof. Rubina Naqvi, MBBS; MD (Nephrology), FISN, PGD Bioethics. Department of Nephrology, Sindh Institute of Urology and Transplantation (SIUT), Civil Hospital, Karachi, Pakistan
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14
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D Ephraim RK, Adoba P, Sakyi SA, Aporeigah J, Fondjo LA, Botchway FA, Storph RP, Toboh E. Acute kidney injury in pediatric patients with malaria: A prospective cross-sectional study in the shai-osudoku district of Ghana. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2021; 31:235-244. [PMID: 32129218 DOI: 10.4103/1319-2442.279946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acute kidney injury (AKI) is a highly fatal complication of malaria. We used the Kidney Disease Improving Global Outcomes (KDIGO) and Pediatric Risk, Injury, Failure, Loss, End-Stage Kidney Disease (pRIFLE) guidelines to assess AKI among children. One hundred children with Plasmodium falciparum malaria were recruited from the St. Andrew's Catholic Hospital. Admission and 48-h serum creatinine were estimated. Weight and height of the participants were measured, and AKI status determined with the KDIGO and pRIFLE guidelines. A questionnaire was used to collect the socio-demographic and clinical data of participants. Two percent and 5% of the participants had AKI according to the KDIGO and pRIFLE criteria, respectively. Per the KDIGO guidelines, 1% of the participants had Stage 2 and 1% also had Stage 3 AKI. Four percent had Stage 1 (risk) and 1% had Stage 2 (injury) AKI per the pRIFLE criteria. Participants with AKI were dehydrated, and neither had sepsis or on antibiotics when the KDIGO guideline was used. Participants who had AKI were dehydrated, with 80% having sepsis and 40% on antibiotics when the pRIFLE criteria were used. There was no association between the KDIGO and pRIFLE criteria with respect to AKI status of participants (k = -0.029, P = 0.743). Two percent and 5% of the study participants had AKI when the KDIGO and pRIFLE guidelines were used respectively. One percent of the participants had Stage 2 and 1% also had Stage 3 AKI per KDIGO; 4% had Stage 1 (risk) and 1% had Stage 2 (injury) AKI per the pRIFLE.
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Affiliation(s)
- Richard K D Ephraim
- Department of Medical Laboratory Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Prince Adoba
- Department of Medical Laboratory Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Samuel A Sakyi
- Department of Molecular Medicine, School Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Josephine Aporeigah
- Department of Medical Laboratory Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Linda A Fondjo
- Department of Molecular Medicine, School Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Felix A Botchway
- Department of Chemical Pathology, School of Basic and Allied Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Rebecca P Storph
- Department of Medical Laboratory Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Emmanuel Toboh
- Medical Laboratory Unit, Dansoman Polyclinic, Accra, Ghana
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15
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Afolayan FM, Adedoyin OT, Abdulkadir MB, Ibrahim OR, Biliaminu SA, Mokuolu OA, Ojuawo A. Acute Kidney Injuries in Children with Severe Malaria: A comparative study of diagnostic criteria based on serum cystatin C and creatinine levels. Sultan Qaboos Univ Med J 2020; 20:e312-e317. [PMID: 33414935 PMCID: PMC7757922 DOI: 10.18295/squmj.2020.20.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 05/04/2020] [Accepted: 06/03/2020] [Indexed: 01/08/2023] Open
Abstract
Objectives Serum creatinine levels are often used to diagnose acute kidney injury (AKI), but may not necessarily accurately reflect changes in glomerular filtration rate (GFR). This study aimed to compare the prevalence of AKI in children with severe malaria using diagnostic criteria based on creatinine values in contrast to cystatin C. Methods This prospective cross-sectional study was performed between June 2016 and May 2017 at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. A total of 170 children aged 0.5–14 years old with severe malaria were included. Serum cystatin C levels were determined using a particle-enhanced immunoturbidmetric assay method, while creatinine levels were measured using the Jaffe reaction. Renal function assessed using cystatin C-derived estimated GFR (eGFR) was compared to that measured using three sets of criteria based on creatinine values including the Kidney Disease: Improved Global Outcomes (KDIGO) and World Health Organization (WHO) criteria as well as an absolute creatinine cut-off value of >1.5 mg/dL. Results Mean serum cystatin C and creatinine levels were 1.77 ± 1.37 mg/L and 1.23 ± 1.80 mg/dL, respectively (P = 0.002). According to the KDIGO, WHO and absolute creatinine criteria, the frequency of AKI was 32.4%, 7.6% and 16.5%, respectively. In contrast, the incidence of AKI based on cystatin C-derived eGFR was 51.8%. Overall, the rate of detection of AKI was significantly higher using cystatin C compared to the KDIGO, WHO and absolute creatinine criteria (P = 0.003, <0.001 and <0.001, respectively). Conclusion Diagnostic criteria for AKI based on creatinine values may not indicate the actual burden of disease in children with severe malaria.
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Affiliation(s)
- Folake M Afolayan
- Department of Paediatrics & Child Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Olanrewaju T Adedoyin
- Department of Paediatrics & Child Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria.,Department of Paediatrics & Child Health, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
| | - Mohammed B Abdulkadir
- Department of Paediatrics & Child Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria.,Department of Paediatrics & Child Health, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
| | - Olayinka R Ibrahim
- Department of Pediatrics, Federal Medical Centre, Katsina State, Nigeria
| | - Sikiru A Biliaminu
- Department of Chemical Pathology & Immunology, University of Ilorin Teaching Hospital, Ilorin, Nigeria.,Department of Chemical Pathology & Immunology, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
| | - Olugbenga A Mokuolu
- Department of Paediatrics & Child Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria.,Department of Paediatrics & Child Health, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
| | - Ayodele Ojuawo
- Department of Paediatrics & Child Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria.,Department of Paediatrics & Child Health, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
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16
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Abstract
Asia is the largest and most populous continent and has huge differences in socioeconomic status, development, and health care between the different countries and regions within each country. This manifests in the varied causes of acute kidney injury (AKI), particularly higher rates of community-acquired AKI and in the differential access to health care for the population. Because of resource limitations, prevention and treatment of AKI is a difficult challenge. This review highlights the differences in AKI in Asia compared with the developed world and discusses prevention and treatment of AKI within the context of resource limitations.
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17
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Expression of 4-Hydroxynonenal (4-HNE) and Heme Oxygenase-1 (HO-1) in the Kidneys of Plasmodium berghei-Infected Mice. J Trop Med 2020; 2020:8813654. [PMID: 33149743 PMCID: PMC7603615 DOI: 10.1155/2020/8813654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/24/2020] [Accepted: 10/10/2020] [Indexed: 11/18/2022] Open
Abstract
Acute kidney injury (AKI) is one of the most serious complications of severe Plasmodium falciparum malaria, but the exact pathogenic mechanisms of AKI in P. falciparum infection have not been clearly elucidated. We hypothesized that oxidative stress is a potential mediator of acute tubular necrosis in P. falciparum-infected kidneys. Therefore, this study aimed to investigate the histopathological changes and markers of oxidative stress in kidney tissues from mice with experimental malaria. DBA/2 mice were divided into two groups: the mice in the malaria-infected group (n = 10) were intraperitoneally injected with 1 × 106P. berghei ANKA-infected red blood cells, and the mice in the control group (n = 10) were intraperitoneally injected with a single dose of 0.85% normal saline. Kidney sections were collected and used for histopathological examination and the investigation of 4-hydroxynonenal (4-HNE) and heme oxygenase-1 (HO-1) expression through immunohistochemistry staining. The histopathology study revealed that the P. berghei-infected kidneys exhibited a greater area of tubular necrosis than those of the control group (p < 0.05). The positive staining scores for 4-HNE and HO-1 expression in tubular epithelial cells of the P. berghei-infected group were significantly higher than those found for the control group (p < 0.05). In addition, significant positive correlations were found between the tubular necrosis score and the positive staining scores for 4-HNE and HO-1 in the kidneys from the P. berghei-infected group. In conclusion, this finding demonstrates that increased expression of 4-HNE and HO-1 might be involved in the pathogenesis of acute tubular damage in the kidneys during malaria infection. Our results provide new insights into the pathogenesis of malaria-associated AKI and might provide guidelines for the future development of a therapeutic intervention for malaria.
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18
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Duarte DB, Lacerda MCSR, Ribeiro YJP, Ribeiro MZD, Frederico MDA, Oliveira MJC. Kidney biomarkers in tropical infections: an update. Pathog Glob Health 2020; 114:302-308. [PMID: 32726193 PMCID: PMC7480515 DOI: 10.1080/20477724.2020.1799605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Neglected tropical diseases affect over 1 billion people, and cause 170,000 deaths each year. They result in disability, stigma and disfigurement, and also push families into poverty. Tropical infections can involve the kidney, presenting as a wide variety of ways, varying from transient urinary abnormalities to severe acute kidney injury (AKI). It is important to assess renal function in patients with tropical infections for earlier detection of AKI, appropriate treatment and prevention of Chronic Kidney Disease (CKD) outcome in some of them. There was an exponential increase in research on new kidney biomarkers that were earlier and specific for renal damage but few in the scope of tropical infections. In this review, we focus on kidney biomarkers that are being studied in some of the most prevalent tropical infections such as visceral leishmaniasis, leptospirosis, malaria, schistosomiasis and leprosy. Further studies are needed to evaluate the usefulness of renal biomarkers in the early diagnosis of renal diseases associated with tropical infections.
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Affiliation(s)
- Daniella Bezerra Duarte
- Post-Graduation Program in Medical Sciences, Department of
Internal Medicine, Federal University of Ceará, Fortaleza, Brazil
- School of Medicine, Federal University of Alagoas, Maceió, Brazil
- School of Medicine, Tiradentes University Center, Maceió, Brazil
- School of Medicine, CESMAC University Center, Maceió, Brazil
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19
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Brown DD, Solomon S, Lerner D, Del Rio M. Malaria and acute kidney injury. Pediatr Nephrol 2020; 35:603-608. [PMID: 30706124 DOI: 10.1007/s00467-018-4191-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 12/19/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022]
Abstract
Malaria is a parasitic infection transmitted by mosquitos, resulting in significant morbidity and mortality. It affects 212 million worldwide, causing death in up to 303,000 children annually. In the USA, up to 1700 people are affected yearly. Although the prevalence in developed countries is less than in developing countries, travelers from low transmission areas, and those from endemic areas who later return, are very susceptible to malaria and its complications. Severe malaria can cause significant multiorgan dysfunction including acute kidney injury (AKI). The pathogenesis is not clearly understood but proposed mechanisms include acute tubular necrosis (ATN) due to impediments in renal microcirculation, infection-triggered proinflammatory reactions within the kidney, and metabolic disturbances. Providers must consider malarial infection in cases of AKI in someone with a travel history, as early recognition and treatment are crucial to improving outcomes. This article will review malaria-induced AKI in order to provide a better understanding of this infection's effect on the kidneys.
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Affiliation(s)
- Denver D Brown
- Department of Pediatric Nephrology at The Children's Hospital at Montefiore, 3326 Bainbridge Ave, Bronx, NY, 10029, USA.
| | - Sonia Solomon
- Department of Pediatric Nephrology at The Children's Hospital at Montefiore, 3326 Bainbridge Ave, Bronx, NY, 10029, USA
| | - Daniele Lerner
- Department of Pediatric Nephrology at The Children's Hospital at Montefiore, 3326 Bainbridge Ave, Bronx, NY, 10029, USA
| | - Marcela Del Rio
- Department of Pediatric Nephrology at The Children's Hospital at Montefiore, 3326 Bainbridge Ave, Bronx, NY, 10029, USA
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Sacomboio ENM, Santos Sebastião CD, Tchivango AT, Pecoits-Filho R, Calice-Silva V. Does parasitemia level increase the risk of acute kidney injury in patients with malaria? Results from an observational study in Angola. SCIENTIFIC AFRICAN 2020. [DOI: 10.1016/j.sciaf.2019.e00232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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21
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Malaria. HIGHLY INFECTIOUS DISEASES IN CRITICAL CARE 2020. [PMCID: PMC7120402 DOI: 10.1007/978-3-030-33803-9_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Malaria is a significant cause of morbidity and mortality throughout the world, and environmental changes are likely to increase its importance in the coming years. Diagnosing this disease is difficult and requires a high index of suspicion, especially in non-endemic countries. Critical care providers play a major role in treating severe malaria and its complications, which has management particularities that might not be readily apparent. Fluid resuscitation should be carefully tailored to avoid complications, and dysperfusion seems more related to degree of parasitemia than hypovolemia. Antimalarial agents are effective, but resistance is growing. Complications can be found in nearly every organ, including cerebral malaria, acute respiratory distress syndrome, and acute kidney injury. As such, a critical care unit is frequently required for organ support when they appear. Superimposed infections are not infrequent. Despite all of this, mortality is encouragingly low with a timely diagnosis and access to appropriate treatment.
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22
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Edagha IA, Ekpo AJ, Edagha EI, Bassey JV, Nyong TP, Akpan AS, Obeten RF, Okon AS, Ating BA. Investigating the Comparative Effects of Six Artemisinin-based Combination Therapies on Plasmodium-induced Hepatorenal Toxicity. Niger Med J 2019; 60:211-218. [PMID: 31831942 PMCID: PMC6892336 DOI: 10.4103/nmj.nmj_152_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 06/30/2019] [Accepted: 07/30/2019] [Indexed: 01/23/2023] Open
Abstract
Background Too many artemisinin-based combination therapies (ACTs) are available, thus creating a dilemma on the most preferred for the treatment of malaria. Aim We compared the effect of six ACTs in mitigating Plasmodium-induced hepatorenal toxicity in experimental malaria. Materials and Methods Forty adult male Swiss mice allotted into eight groups: Group 1 (normal control [NC] uninfected and untreated), Group 2 (parasitized nontreated - [PNT]), and Groups 3-8 received Plasmodium berghei inoculum. After 72 h, the initial parasitemia was established. Groups 3-8 were administered oral therapeutic doses of artesunate-amodiaquine (AA), artesunate-mefloquine (AM), artesunate-sulfadoxine-pyrimethamine (ASP), artemisinin-piperaquine (AP), dihydroartemisinin-piperaquine (DP), and artemether-lumefantrine (AL) per kg bodyweight, respectively, as standard regimen, and final parasitemia determined. Animals were euthanized via chloroform inhalation and blood collected for hepatorenal analysis. Liver and kidney were dissected out for histology. Results Parasitemia was significantly (P < 0.05) decreased in tests compared to PNT, except in ASP group. Liver enzymes were significantly (P < 0.05) increased in PNT compared to tests and NC. Hyperplastic cells and portal tract inflammation were prominent in ASP group, but mild to moderate in other treated groups. Urea-creatinine were significantly (P < 0.05) increased in PNT compared to treated groups. The Na+ and Cl- were significantly (P < 0.05) reduced in PNT, with significantly (P < 0.05) increased K+ compared to NC and treated groups. Glomerulonephritis and glomerulus splitting was observed in PNT, while moderate distortions were observed in treated groups. The AA and AM groups had good kidney histoarchitecture. Conclusion Parasitemia decreased in all the treatment groups except in PNT and ASP groups which had severe hepatorenal distortions. Hepatorenal histoarchitecture were mildly distorted in the AA, AM and AL-administered groups with lower hepatorenal indices comparable to NC. The least elevated liver enzymes were in AA and AM. In decreasing order ASP > DP > AL > AP > AM > AA.
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Affiliation(s)
- Innocent A Edagha
- Department of Anatomy, Faculty of Basic Medical Sciences, University of Uyo, Uyo, Nigeria
| | - Arit J Ekpo
- Department of Biochemistry, Faculty of Basic Medical Sciences, University of Uyo, Uyo, Nigeria
| | - Edelungudi I Edagha
- Department of Family Medicine, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Joy V Bassey
- Department of Anatomy, Faculty of Basic Medical Sciences, University of Uyo, Uyo, Nigeria
| | - Titus P Nyong
- Department of Anatomy, Faculty of Basic Medical Sciences, University of Uyo, Uyo, Nigeria
| | - Anthony S Akpan
- Department of Biochemistry, Faculty of Basic Medical Sciences, University of Uyo, Uyo, Nigeria
| | - Rose F Obeten
- Department of Biochemistry, Faculty of Basic Medical Sciences, University of Uyo, Uyo, Nigeria
| | - Anthony S Okon
- Department of Biochemistry, Faculty of Basic Medical Sciences, University of Uyo, Uyo, Nigeria
| | - Blessing A Ating
- Department of Biochemistry, Faculty of Basic Medical Sciences, University of Uyo, Uyo, Nigeria
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Prevalence and Factors Associated with Acute Kidney Injury among Malaria Patients in Dar es Salaam: A Cross-Sectional Study. Malar Res Treat 2019; 2019:4396108. [PMID: 31485321 PMCID: PMC6702846 DOI: 10.1155/2019/4396108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/24/2019] [Accepted: 07/02/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Falciparum malaria still remains as a major cause of morbidity and mortality worldwide. Acute kidney injury is a known complication of malaria, and it is reported to occur in up to 40% of adult patients with severe falciparum malaria in endemic regions like sub-Saharan Africa. Objectives To determine the prevalence and factors associated with acute kidney injury among falciparum malaria patients in a tertiary level private hospital in Dar es Salaam. Methodology In a cross-sectional study design, 104 adults with falciparum malaria were enrolled consecutively over 6 months from April to September 2015. The diagnosis of acute kidney injury (AKI) in these patients was established using the KDIGO classification criteria. The prevalence of AKI was obtained at 48 hours from admission and at day 7. Different sociodemographic and clinical parameters which were associated with acute kidney injury at 48 hours and at day 7 were identified by hypothesis testing using chi squared tests followed by multivariate logistic regression analysis. Factors with a p value less than 0.05 were considered significant. Results The participants were predominantly males 65.4% (68/104) and a third (36.5% (38/104)) were between 46 and 65 years. The prevalence of AKI among malaria patients at 48 hours was 26% (27/104). The prevalence of AKI among malaria patients at day 7 was 18.3% (19/104). On multivariate logistic regression, we found that factors that were significantly associated with AKI at 48 hours were male sex (OR 127, CI 3.4–4700, P = 0.008) and hemoglobin <7.5g/dl (OR 36.5, CI 1.7–797.7, P = 0.022), and factor associated with AKI at day 7 was baseline platelet count <25×103 per mm3 (OR 77.8 CI 1.045–5798.6, P = 0.048). Only two patients needed hemodialysis (1.9%) and there were no deaths. Conclusion Acute kidney injury is a common complication in patient with falciparum malaria. When managed well it has an excellent prognosis and necessitates dialysis in only a minority of patients. Male sex and hemoglobin is associated with AKI at 48 hours and baseline platelet count is associated with AKI at 7 days.
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24
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Calice-Silva V, Sacomboio E, Raimann JG, Evans R, Dos Santos Sebastião C, Tchivango AT, Kotanko P, Levin N, Pecoits-Filho R. Diagnostic performance of salivary urea nitrogen dipstick to detect and monitor acute kidney disease in patients with malaria. Malar J 2018; 17:477. [PMID: 30563520 PMCID: PMC6299494 DOI: 10.1186/s12936-018-2627-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 12/12/2018] [Indexed: 11/23/2022] Open
Abstract
Background Acute kidney injury (AKI) is a common complication of malaria. In low resource settings, a lack of diagnostic tools and delayed treatment of malaria associated AKI lead to significant morbidity and mortality. The aim of this study was to assess the diagnostic performance of salivary urea nitrogen (SUN) dipstick to detect and monitor kidney disease [KD = AKI or acute kidney disease (AKD) without AKI] in malaria patients in Angola. Methods Patients 11–50 years old admitted with malaria at the Josina Machel (Maria-Pia) Hospital, Luanda, Angola, between 2nd March and 10th May 2016 were enrolled in this study. All participants had serum creatinine (sCr), blood urea nitrogen (BUN) and SUN dipstick tested at the time of recruitment and daily for up to 4 days. AKD without AKI refers to acute renal impairment which do not fulfilled the main criteria for AKI (increases in the baseline serum creatinine and/or decreases in urine output) according defined by the kidney disease improving global outcomes (KDIGO) guideline. Results Eight-six patients were admitted with malaria diagnosis (mean age 21.5 ± 9.4 years, 71% male) and 27 (32%) were diagnosed with KD. The mean (± SD) sCr and BUN of the KD group at admission (day 0) were 5.38 (± 5.42) and 99.4 (± 61.9) mg/dL, respectively. Three (3.5%) patients underwent haemodialysis and eight (9.3%) died within the first 4 days of hospital admission [5 (62.5%) with KD; 3 (37.5%) without kidney disease; p = 0.047]. The SUN threshold for KD diagnosis was tested pad #5 (SUN > 54 mg/dL). At this threshold, the SUN dipstick had a sensitivity of 67% and specificity of 98% to diagnose KD. The area under the receiver operating characteristics curve (ROC) for KD diagnosis on admission was 0.88 (95% CI 0.79–0.96). The SUN dipstick was most accurate at higher levels of BUN. Conclusion The SUN dipstick had reasonable sensitivity and excellent specificity when used to diagnose KD in a cohort of patients with malaria in a resource-limited setting. Given the severity of presenting illness and kidney injury, the SUN dipstick diagnostic threshold was high (test pad #5). SUN may be used to detect AKI in patients with malaria in low resources settings, thus facilitating earlier access to adequate treatment, which may improve survival. Electronic supplementary material The online version of this article (10.1186/s12936-018-2627-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Viviane Calice-Silva
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil. .,Pro-Rim Foundation, Joinville, Brazil.
| | - Euclides Sacomboio
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.,Higher Institute of Health Sciences/Agostinho Neto University, Luanda, Angola
| | | | - Rhys Evans
- Nephrology Department, Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi.,University College London Centre for Nephrology, London, UK
| | | | | | - Peter Kotanko
- Research Division, Renal Research Institute, New York, USA
| | - Nathan Levin
- Icahn School of Medicine at Mount Sinai, New York, USA
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Prasad N, Patel MR. Infection-Induced Kidney Diseases. Front Med (Lausanne) 2018; 5:327. [PMID: 30555828 PMCID: PMC6282040 DOI: 10.3389/fmed.2018.00327] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 11/07/2018] [Indexed: 12/13/2022] Open
Abstract
Infection induced kidney diseases are of concern for clinicians because timely detection and treatment of infections may cure or limit the extent of injury inflicted by microorganisms causing the infections. Infections can cause kidney injury by either direct invasion, or indirectly by immune mediated mechanisms, which manifest as post-infectious glomerulonephritis, or infection-related glomerulonephritis. Clinical manifestations may be acute or chronic depending on the microorganisms, endemic/epidemic nature and source of infection. All microbials virus, bacteria, mycobacteria, fungus, and protozoa have been implicated in kidney diseases either causing direct kidney injuries or immune-mediated injuries. Infection control practices in large parts of world is limited by poverty, social behavior, high population density, deforestation, inadequate access to safe drinking water, and poor health care facilities. Although, antimicrobials and vaccinations have successfully eradicated and cured many infectious diseases; however injudicious antimicrobial use and emergence of resistant organisms complicated the disease severity like secondary renal amyloidosis with chronic persistent infection. Re-emergence of various infections has been a recent pattern in developed world leading to uncertain diagnostic challenges, and association with kidney diseases.
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Affiliation(s)
- Narayan Prasad
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Manas Ranjan Patel
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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26
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Barraclough KA, Blashki GA, Holt SG, Agar JWM. Climate change and kidney disease-threats and opportunities. Kidney Int 2018; 92:526-530. [PMID: 28807256 DOI: 10.1016/j.kint.2017.03.047] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/16/2017] [Accepted: 03/30/2017] [Indexed: 12/13/2022]
Affiliation(s)
| | - Grant A Blashki
- The Nossal Institute for Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Steve G Holt
- Department of Nephrology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - John W M Agar
- Department of Renal Medicine, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
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27
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Evans RDR, Docherty M, Seeley A, Craik A, Mpugna M, Mann S, Dube Q, Dreyer G, Hemmila U. Incidence, Etiology, and Outcomes of Community-Acquired Acute Kidney Injury in Pediatric Admissions in Malawi. Perit Dial Int 2018; 38:405-412. [PMID: 30257995 DOI: 10.3747/pdi.2017.00253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 05/22/2018] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION The epidemiology of acute kidney injury (AKI) in children in sub-Sahara Africa (SSA) is poorly described. The aim of this study was to establish the incidence, etiology, and outcomes of community-acquired AKI in pediatric admissions in Southern Malawi. METHODS We conducted a prospective observational study of pediatric admissions to a tertiary hospital in Blantyre between 5 February and 30 April 2016. Children were screened for kidney disease on admission with measurement of serum creatinine and assessment of urine output. The clinical presentation, etiology, and management of children with AKI were documented. RESULTS A total of 412 patients (median age 4 years, 52.6% male, and 7.5% human immunodeficiency virus [HIV] infected) were included in the study. Forty-five patients (10.9%) had AKI (Kidney Disease: Improving Global Outcomes [KDIGO] criteria), which was stage 3 in 16 (35.6%) patients. Sepsis and hypoperfusion, most commonly due to malaria (n = 19; 42.2%), were the causes of AKI in 38 cases (84.4%). Three patients (6.7%) underwent peritoneal dialysis (PD) for AKI: 2 of them recovered kidney function, and the other one died. In-hospital mortality was 20.5% in AKI and 2.9% if no kidney disease was present (p < 0.0001). Seventeen (47.2%) patients with kidney disease had persistent kidney injury on hospital discharge. CONCLUSION Acute kidney injury occurs in 10.9% of pediatric admissions in Malawi and is primarily due to infections, particularly malaria. Acute kidney injury results in significantly increased in-hospital mortality. Urgent interventions are required to eliminate preventable causes of death in this region.
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Affiliation(s)
- Rhys D R Evans
- College of Medicine, Blantyre, Malawi .,UCL Centre for Nephrology, London, UK.,Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Marie Docherty
- Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Anna Seeley
- Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Alison Craik
- Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Martha Mpugna
- Paediatric Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Shawna Mann
- Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Queen Dube
- Paediatric Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Gavin Dreyer
- Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi.,Department of Nephrology, Bart's Health NHS Trust, London, UK
| | - Ulla Hemmila
- College of Medicine, Blantyre, Malawi.,Renal Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
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Infections and the kidney: a tale from the tropics. Pediatr Nephrol 2018; 33:1317-1326. [PMID: 28879600 DOI: 10.1007/s00467-017-3785-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 08/01/2017] [Accepted: 08/10/2017] [Indexed: 01/30/2023]
Abstract
Tropical infections are caused by a variety of bacteria, viruses and parasitic organisms across varying geographical regions and are more often reported in adults than in children. Most of the infections are acute, presenting as a febrile illness with involvement of multiple organ systems, including the kidney. The gamut of renal manifestations extends from asymptomatic urinary abnormalities to acute kidney injury and-albeit rarely-chronic kidney disease. Tropical infections can involve the glomerular, tubulointerstitial and vascular compartments of the kidney. Leptospirosis, malaria, dengue, rickettsial fever and schistosomiasis are the most prevalent tropical infections which affect the kidneys of children living in the tropics. In this review we discuss renal involvement in these most prevalent tropical infections.
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29
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Defauw P, Daminet S, Leisewitz A, Goddard A, Paepe D, Duchateau L, Schoeman J. Renal azotemia and associated clinical and laboratory findings in dogs with Babesia rossi infection. Vet Parasitol 2018; 260:22-29. [DOI: 10.1016/j.vetpar.2018.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/28/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
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Acute Kidney Injury in the Tropics: Epidemiology, Presentation, Etiology, Specific Diseases, and Treatment. CORE CONCEPTS IN ACUTE KIDNEY INJURY 2018. [PMCID: PMC7119979 DOI: 10.1007/978-1-4939-8628-6_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The characteristics of AKI are significantly influenced by the setting in which it develops. The unique characteristics in the tropical ecosystem along with the prevailing socioeconomic circumstances in the region make AKI in the tropics different regarding etiology, clinical characteristics, and outcomes. Community-acquired AKI caused by infections; animal, plant, or chemical toxins; and obstetric complications are common in the tropics, compared to predominantly hospital-acquired AKI from sepsis and diagnostic and therapeutic interventions elsewhere. It is possible to discern certain distinct “AKI syndromes” in the tropics, like febrile illness with AKI, envenomation-related AKI, and obstetric AKI, where the patients develop AKI along with a typical constellation of clinical features, allowing more specific and quick diagnostic and therapeutic approach. Changes in disease epidemiology and ongoing socioeconomic transitions in the tropics are reflected in changing epidemiology of tropical AKI. While the incidence of obstetric AKI has shown a steady decline, HIV-associated AKI emerged as a significant entity in regions where HIV was endemic in the past few decades. There is better recognition of scrub typhus as a significant contributor to AKI with availability of better diagnostic techniques, and it is well recognized that the epidemiology of AKI associated with post-infectious glomerulonephritis is different in the tropics. Rapid urbanization has made large swaths of population susceptible to emerging infections like dengue fever, with increased incidence of AKI. Climate change and scarcity of potable water are expected to pose significant challenges to kidney health in the tropics in the future. However, community-acquired AKI in the tropics also presents a unique opportunity for prevention of AKI, and attendant morbidity and mortality as most of the contributing factors can be addressed by public health interventions and innovative strategies to deliver healthcare.
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Tobón-Castaño A, Barrera Escobar S, Giraldo Castro C. Urinalysis and Clinical Correlations in Patients with P. vivax or P. falciparum Malaria from Colombia. J Trop Med 2017; 2017:7868535. [PMID: 28630631 PMCID: PMC5463173 DOI: 10.1155/2017/7868535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/30/2017] [Accepted: 05/02/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Urinalysis is a poorly reviewed diagnostic tool in malaria patients; its application can show the presence of severe malaria. METHODS Urinalysis was performed in a total of 620 patients diagnosed with malaria by thick blood smear; complications were classified according to WHO major criteria for severity and minor criteria according to the Colombian malaria guideline. RESULTS Severe or moderate clinical complications were diagnosed in 31.1% of patients, hepatic dysfunctions were diagnosed in 25.8%, anemia was diagnosed in 9.8%, thrombocytopenia was diagnosed in 7.7%, renal dysfunction was diagnosed in 4.8%, neurological and pulmonary complications were diagnosed in 2.1% and 2.4%, hypoglycemia was diagnosed in 1.1% of patients with blood glucose analysis, and acidosis was diagnosed in 10 of 25. Bilirubinuria was found in 24.3%, associated with urobilinuria, proteinuria, and increased specific gravity; urobilinuria was found in 30.6% associated with elevated serum bilirubin and alanine aminotransferase; 39.2% had proteinuria, associated with higher blood urea nitrogen, serum bilirubin, aspartate, alanine-transaminase, hematuria, and increased specific gravity. Severe or moderate liver and renal complications were associated with proteinuria and bilirubinuria. Urobilinuria was associated with thrombocytopenia and neurological and hepatic dysfunction. Ketonuria was associated with neurological dysfunctions. CONCLUSIONS The most frequent alterations in the urinalysis were bilirubinuria, proteinuria, urobilinuria, and increased specific gravity, related to thrombocytopenia and liver, kidney, and neurological alterations.
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Affiliation(s)
- Alberto Tobón-Castaño
- Malaria Group, Faculty of Medicine, University of Antioquia, Calle 70, No. 52-21, Medellin, Colombia
| | - Sebastián Barrera Escobar
- Malaria Group, Faculty of Medicine, University of Antioquia, Calle 70, No. 52-21, Medellin, Colombia
- Faculty of Medicine, University of Antioquia, Medellin, Colombia
| | - Cecilia Giraldo Castro
- Malaria Group, Faculty of Medicine, University of Antioquia, Calle 70, No. 52-21, Medellin, Colombia
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Yao KH, Konan SD, Tia WM, Diopoh SP, Moh R, Sanogo S. Outcomes of acute kidney injury in a department of internal medicine in ABIDJAN (cote D'IVOIRE). Nephrology (Carlton) 2017; 23:653-660. [PMID: 28444694 DOI: 10.1111/nep.13064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 04/21/2017] [Accepted: 04/21/2017] [Indexed: 12/15/2022]
Abstract
AIM To investigate the prognostic factors of acute kidney injury (AKI) in our daily practice. METHODS We analyzed the cohort of patients hospitalized for AKI in the period from January 2010 to December 2015 in the Department of Internal Medicine, University Hospital of Treichville. Kaplan-Meier curves were built for survival analysis. Cox regression analysis was used to identify independent predictors of mortality. RESULTS We collected 414 cases of AKI during the study period. The mean age was 48.3 ± 16.8 years. We observed a male predominance with a sex ratio (236/178) of 1.32. In multivariate analysis, the predictive factors of death were age ≥ 65 years (HR = 2.13; 95% CI = 1.28-3.55; P = 0.004), AKI stage 3 (HR = 1.69; 95%CI = 1.13-2.50; P = 0.009), haemoglobin <8 g/dL (HR = 2.91; 95% CI = 1.79-4.72; P = 0.0001), infection (HR = 1.85; 95% CI = 1.21-2.83; P = 0.004) and drug-induced AKI (HR = 3.23; 95% CI = 1.65-6.29; P = 0.001). Factors associated with incomplete recovery or non-recovery of renal function beyond 3 months were age ≥ 65 years (OR = 4.76; 95% CI = 1.85-12.50;P = 0.001), hypertension (OR = 2.17; 95% CI = 1.07-4.34; P = 0.03), haemoglobin <8 g/dL (OR = 6.66; 95% CI = 2.94-8.28; P < 0.001), AKI stage 3 (OR = 9.09; 95% CI = 4.54-16.66; P < 0.001) malignant hypertension (OR = 5; 95% CI = 1.67-7.27; P = 0.005) and cancer (OR = 4.69; 95% CI = 2.22-6.63; P = 0.001). CONCLUSION The aetiologies are dominated by infections. The fatality rate is high and its risk factors are advanced age, low haemoglobin level, severe AKI, infection and drug intake. Prevention is essential.
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Affiliation(s)
- Kouamé Hubert Yao
- Department of Nephrology and Internal Medicine, University-Hospital of Treichville, Abidjan, Côte d'Ivoire
| | - Serge Didier Konan
- Department of Nephrology and Internal Medicine, University-Hospital of Treichville, Abidjan, Côte d'Ivoire
| | - Weu Melanie Tia
- Department of Nephrology, University-Hospital of Yopougon, Abidjan, Côte d'Ivoire
| | - Sery Patrick Diopoh
- Department of Nephrology and Internal Medicine, University-Hospital of Treichville, Abidjan, Côte d'Ivoire
| | - Raoul Moh
- Progamme PACCI, Site ANRS de, Côte d'Ivoire.,Department of Infectiology and Dermatology, University-Hospital of Treichville, Abidjan, Côte d'Ivoire
| | - Sindou Sanogo
- Department of Nephrology and Internal Medicine, University-Hospital of Treichville, Abidjan, Côte d'Ivoire
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Wichapoon B, Punsawad C, Viriyavejakul P. Expression of cleaved caspase-3 in renal tubular cells in Plasmodium falciparum malaria patients. Nephrology (Carlton) 2017; 22:79-84. [PMID: 26729581 DOI: 10.1111/nep.12715] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 12/24/2015] [Accepted: 12/28/2015] [Indexed: 11/28/2022]
Abstract
AIM In Plasmodium falciparum malaria, the clinical manifestation of acute kidney injury (AKI) is commonly associated with acute tubular necrosis (ATN) in the kidney tissues. Renal tubular cells often exhibit various degrees of cloudy swelling, cell degeneration, and frank necrosis. To study individual cell death, this study evaluates the degree of renal tubular necrosis in association with apoptosis in malarial kidneys. METHODS Kidney tissues from P. falciparum malaria with AKI (10 cases), and without AKI (10 cases) were evaluated for tubular pathology. Normal kidney tissues from 10 cases served as controls. Tubular necrosis was assessed quantitatively in kidney tissues infected with P. falciparum malaria, based on histopathological evaluation. In addition, the occurrence of apoptosis was investigated using cleaved caspase-3 marker. Correlation between tubular necrosis and apoptosis was analyzed. RESULTS Tubular necrosis was found to be highest in P. falciparum malaria patients with AKI (36.44% ± 3.21), compared to non-AKI (15.88% ± 1.63) and control groups (2.58% ± 0.39) (all p < 0.001). In the AKI group, the distal tubules showed a significantly higher degree of tubular necrosis than the proximal tubules (p = 0.021) and collecting tubules (p = 0.033). Tubular necrosis was significantly correlated with the level of serum creatinine (r = 0.596, p = 0.006), and the occurrence of apoptosis (r = 0.681, p = 0.001). CONCLUSION In malarial AKI, the process of apoptosis occurs in ATN.
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Affiliation(s)
- Benjamas Wichapoon
- Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand
| | - Chuchard Punsawad
- School of Medicine, Walailak University, 222 Thasala District, Nakhon Si Thammarat, 80161, Thailand
| | - Parnpen Viriyavejakul
- Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand
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Burdmann EA, Jha V. Acute kidney injury due to tropical infectious diseases and animal venoms: a tale of 2 continents. Kidney Int 2017; 91:1033-1046. [PMID: 28088326 DOI: 10.1016/j.kint.2016.09.051] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/10/2016] [Accepted: 09/28/2016] [Indexed: 12/20/2022]
Abstract
South and Southeast Asia and Latin American together comprise 46 countries and are home to approximately 40% of the world population. The sociopolitical and economic heterogeneity, tropical climate, and malady transitions characteristic of the region strongly influence disease behavior and health care delivery. Acute kidney injury epidemiology mirrors these inequalities. In addition to hospital-acquired acute kidney injury in tertiary care centers, these countries face a large preventable burden of community-acquired acute kidney injury secondary to tropical infectious diseases or animal venoms, affecting previously healthy young individuals. This article reviews the epidemiology, clinical picture, prevention, risk factors, and pathophysiology of acute kidney injury associated with tropical diseases (malaria, dengue, leptospirosis, scrub typhus, and yellow fever) and animal venom (snakes, bees, caterpillars, spiders, and scorpions) in tropical regions of Asia and Latin America, and discusses the potential future challenges due to emerging issues.
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Affiliation(s)
- Emmanuel A Burdmann
- LIM 12, Division of Nephrology, University of São Paulo Medical School, São Paulo, Brazil.
| | - Vivekanand Jha
- George Institute for Global Health, New Delhi, India, and University of Oxford, Oxford, UK
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35
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Yao KH, Guei MC, Tia WM, Konan SD, Diopoh SP, Sanogo S. Comparative study of community acute kidney injury in young patients versus elderly patients in an internal medicine department in Abidjan (Côte d’Ivoire). J Renal Inj Prev 2016. [DOI: 10.15171/jrip.2017.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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36
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Tropical Diseases Nephropathy - An Underemphasized Comorbidity. ARS MEDICA TOMITANA 2016. [DOI: 10.1515/arsm-2016-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractThe tropical areas are a home to a number of diseases because of the hot & humid climate, and lack of health care facilities. Tropical Nephropathies are a major health problem and a matter of great concern. The main causes of kidney injury in tropics are due to bacterial, viral or parasitic infections like malaria, dengue, leptospirosis, scrub typhus, acute gastroenteritis, tuberculosis, leprosy and toxic envenomations like snake bite. Renal injury associated with tropical infections has a wide spectrum of presentations ranging from acute kidney injury to chronic kidney disease. Renal involvement in infectious diseases by one or other mechanism is a definite cause of increased morbidity and mortality. Proper understanding of these diseases, early diagnosis, patient education and improved health care facilities will lead to a better outcome and improved survival. This article reviews the various tropical infections causing kidney injury including pathophysiology and line of management.
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37
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van Wolfswinkel ME, Koopmans LC, Hesselink DA, Hoorn EJ, Koelewijn R, van Hellemond JJ, van Genderen PJJ. Neutrophil gelatinase-associated lipocalin (NGAL) predicts the occurrence of malaria-induced acute kidney injury. Malar J 2016; 15:464. [PMID: 27612570 PMCID: PMC5017124 DOI: 10.1186/s12936-016-1516-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/02/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a frequently encountered complication of imported Plasmodium falciparum infection. Markers of structural kidney damage have been found to detect AKI earlier than serum creatinine-based prediction models but have not yet been evaluated in imported malaria. This pilot study aims to explore the predictive performance of neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) for AKI in travellers with imported P. falciparum infection. METHODS Thirty-nine patients with imported falciparum malaria from the Rotterdam Malaria Cohort with available serum and urine samples at presentation were included. Ten of these patients met the criteria for severe malaria. The predictive performance of NGAL and KIM-1 as markers for AKI was compared with that of serum creatinine. RESULTS Six of the 39 patients (15 %) developed AKI. Serum and urine NGAL and urine KIM-1 were all found to have large areas under the receiver operating characteristics curves (AUROC) for predicting AKI. Urine NGAL was found to have an excellent performance with positive predictive value (PPV) of 1.00 (95 % CI 0.54-1.00), a negative predictive value (NPV) of 1.00 (95 % CI 0.89-1.00) and an AUROC of 1.00 (95 % CI 1.00-1.00). CONCLUSION A good diagnostic performance of NGAL and KIM-1 for AKI was found. Particularly, urine NGAL was found to have an excellent predictive performance. Larger studies are needed to demonstrate whether these biomarkers are superior to serum creatinine as predictors for AKI in P. falciparum malaria.
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Affiliation(s)
- Marlies E van Wolfswinkel
- Harbour Hospital and Institute for Tropical Diseases, Rotterdam, The Netherlands. .,Department of Medical Microbiology and Infectious Diseases, Erasmus MC and Harbour Hospital and Institute for Tropical Diseases, Rotterdam, The Netherlands.
| | - Liese C Koopmans
- Harbour Hospital and Institute for Tropical Diseases, Rotterdam, The Netherlands
| | | | - Ewout J Hoorn
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Rob Koelewijn
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC and Harbour Hospital and Institute for Tropical Diseases, Rotterdam, The Netherlands
| | - Jaap J van Hellemond
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC and Harbour Hospital and Institute for Tropical Diseases, Rotterdam, The Netherlands
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Mohapatra MK, Behera AK, Karua PC, Bariha PK, Rath A, Aggrawal KC, Nahak SR, Gudaganatti SS. Urinary bile casts in bile cast nephropathy secondary to severe falciparum malaria. Clin Kidney J 2016; 9:644-8. [PMID: 27478612 PMCID: PMC4957722 DOI: 10.1093/ckj/sfw042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/23/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Severe cholestatic jaundice may complicate with bile cast nephropathy (BCN) causing severe acute kidney injury (AKI). In this study, we investigate BCN in severe falciparum malaria complicated with jaundice and AKI. METHODS This prospective study was conducted in a tertiary health care institution with high prevalence of malaria. A cohort of 110 patients with falciparum malaria complicated with cerebral malaria, jaundice and AKI were enrolled. Species diagnosis was made from peripheral blood smear or rapid diagnostic test. Severe malaria was diagnosed from WHO criteria. BCN was diagnosed with the detection of bile casts in urine or in biopsy. The recovery pattern and outcome with and without BCN was assessed. RESULTS Out of 110 patients, 20 (18.2%) patients had BCN and 15 (13.6%) patients had hepato-renal syndrome. Patients with BCN had high conjugated bilirubin (26.5 ± 4.1 mg/dL), urea (75.9 ± 10.3 mg/dL) and creatinine (7.2 ± 0.8 mg/dL), longer duration of illness (6.4 ± 1.1 days), higher mortality (25.0%) and prolonged recovery time of hepatic (9.6 ± 2.4 days) and renal dysfunction (15.1 ± 6.5 days) compared with patients without BCN. CONCLUSIONS Prolonged duration of illness and increased bilirubin cause BCN among patients with severe falciparum malaria with jaundice and AKI, which is associated with high mortality and morbidity.
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Affiliation(s)
- Manoj Kumar Mohapatra
- Department of Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha , India
| | - Ashok Kumar Behera
- Department of Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha , India
| | - Purna Chandra Karua
- Department of Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha , India
| | - Prafulla Kumar Bariha
- Department of Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha , India
| | - Ashutosh Rath
- Department of Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha , India
| | - Kailash Chandra Aggrawal
- Department of Pathology, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha , India
| | - Snigdha Rani Nahak
- Department of Pathology, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha , India
| | - Santosh Shankar Gudaganatti
- Department of Pathology, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha , India
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Yang L. Acute Kidney Injury in Asia. KIDNEY DISEASES 2016; 2:95-102. [PMID: 27921036 DOI: 10.1159/000441887] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/18/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is a common disorder and is associated with a high morbidity and mortality worldwide. The diversity of the climate and of the socioeconomic and developmental status in Asia has a great influence on the etiology and presentation of AKI in different regions. In view of the International Society of Nephrology's 0by25 initiative, more and more attention has been paid to AKI in Asian countries. SUMMARY In this review, we summarize the recent achievements with regard to the prevalence and clinical patterns of AKI in Asian countries. Epidemiological studies have revealed the huge medical and economic burden of AKI in Eastern Asian countries, whereas the true epidemiological picture of AKI in the tropical areas is still not well understood. In high-income Asian regions, the presentation of AKI resembles that in other developed countries in Europe and North America. In low-income regions and tropical areas, infections, environmental toxins, and obstetric complications remain the major culprits in most cases of AKI. Preventive opportunities are missed because of failure to recognize the risk factors and early signs of AKI. Patients often present late for treatment or are recognized late by physicians, which leads to more severe kidney injury, multiorgan involvement, and increased mortality. There is significant undertreatment of AKI in many regions, and medical resources for renal replacement therapy are not universally available. KEY MESSAGES More efforts should be made to increase public awareness, establish preventive approaches in communities, educate health-care practitioner entities to achieve better recognition, and form specialist renal teams to improve the treatment of AKI. The choice of renal replacement therapy should fit patients' needs, and peritoneal dialysis can be practiced more frequently in the treatment of AKI patients. FACTS FROM EAST AND WEST (1) More than 90% of the patients recruited in AKI studies using KDIGO-equivalent criteria originate from North America, Europe, or Oceania, although these regions represent less than a fifth of the global population. However, the pooled incidence of AKI in hospitalized patients reaches 20% globally with moderate variance between regions. (2) The lower incidence rates observed in Asian countries (except Japan) may be due to a poorer recognition rate, for instance because of less systematically performed serum creatinine tests. (3) AKI patients in South and Southeastern Asia are younger than in East Asia and Western countries and present with fewer comorbidities. (4) Asian countries (and to a certain extent Latin America) face specific challenges that lead to AKI: nephrotoxicity of traditional herbal and less strictly regulated nonprescription medicines, environmental toxins (snake, bee, and wasp venoms), and tropical infectious diseases (malaria and leptospirosis). A higher incidence and less efficient management of natural disasters (particularly earthquakes) are also causes of AKI that Western countries are less likely to encounter. (5) The incidence of obstetric AKI decreased globally together with an improvement in socioeconomic levels particularly in China and India in the last decades. However, antenatal care and abortion management must be improved to reduce AKI in women, particularly in rural areas. (6) Earlier nephrology referral and better access to peritoneal dialysis should improve the outcome of AKI patients.
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Affiliation(s)
- Li Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, and Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing, China
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Prasad R, Mishra OP. Acute Kidney Injury in Children with Plasmodium falciparum Malaria: Determinants for Mortality. Perit Dial Int 2016; 36:213-7. [PMID: 26429418 PMCID: PMC4803368 DOI: 10.3747/pdi.2014.00254] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 05/03/2015] [Indexed: 02/03/2023] Open
Abstract
UNLABELLED ♦ BACKGROUND Acute kidney injury (AKI) in P. falciparum malaria infection is an important morbidity in children. The purpose of the present study was done to observe the renal involvement, associated morbidities and outcome. ♦ METHODS Out of 156 patients with severe P. falciparum malaria, diagnosed on the basis of compatible clinical presentations and positive malarial parasites in the peripheral blood smear and/or histidine rich protein 2 antigen, 31 had AKI at presentation and were analyzed. ♦ RESULTS Of 31 (19.9%) patients with AKI, 4 were classified at risk, 11 injury, and 16 failure stage, as per pRIFLE criteria (pediatric version of RIFLE [R = risk, I = injury, F = failure, L = loss E = end-stage kidney disease]). Mean age of children with AKI was 7.7 ± 3.2 years. A significantly higher proportion of patients with AKI had hypoglycemia (41.9%), pulmonary edema (32.2%), and disseminated intravascular coagulation (DIC) (29.0%) compared to those without AKI (18.4%, 4.8%, and 3.2%, respectively). Twelve patients (38.7%) required peritoneal dialysis (PD), 8 (25.8%) died, and all were in failure stage. The non-survivors had significantly higher blood urea (p = 0.005) and serum creatinine levels (p = 0.042), lower glomerular filtration rate (p < 0.001), longer duration of illness (p = 0.003), and oliguria/anuria (p = 0.001) than survivors at admission. On logistic regression analysis, the disseminated intravascular coagulation (DIC), jaundice and parasite density (≥ 3+) were found to be significant factors contributing to mortality in children with AKI. ♦ CONCLUSIONS Acute kidney injury in falciparum malaria is one of the severe systemic complications. Duration of illness and presence of comorbidities adversely affected the outcome.
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Affiliation(s)
- Rajniti Prasad
- Division of Pediatric Nephrology, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
| | - Om P Mishra
- Division of Pediatric Nephrology, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
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Abstract
Objective: To report patients developing acute kidney injury (AKI) after Vivax malaria. Methods: An observational cohort of patients identified as having acute kidney injury (AKI) after Plasmodium vivax infection. AKI was defined according to RIFLE criteria with sudden rise in creatinine or decline in urine output or both. All patients had normal size non obstructed kidneys on ultrasonography, with no previous co morbids. Malarial parasite Vivax was seen on blood peripheral film in all patients. Results: From January 1990 – December 2014, total 5623 patients with AKI were registered in our institute, of these 671 (11.93%) developed AKI in association with malarial infection, furthermore, Vivax was species in 109 patients. Average age of patients was 33.49±14.67 (range 8-78 years) with 66 male and 43 female. Oligo-anuria and vomiting were most common associated symptoms with fever. Renal replacement therapy required in 82 (75.22%) patients. Complete recovery was seen in 69 (63.30%), while 14 (12.84%) expired during acute phase of illness. Jaundice, thrombocytopenia, central nervous system involvement, mechanical ventilation requirement and hematuria were the factors significantly associated with high mortality. Conclusion: Malaria still causing significant morbidity and mortality in our part of world. Vivax malaria can present with hemolysis, thrombocytopenia and kidney failure in remarkable number of patients.
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Affiliation(s)
- Rubina Naqvi
- Prof. Dr. Rubina Naqvi Professor of Nephrology, Sindh Institute of Urology and Transplantation (SIUT), Karachi. Pakistan
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42
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Zanfini BA, Dell'Anna AM, Catarci S, Frassanito L, Vagnoni S, Draisci G. Anesthetic management of urgent cesarean delivery in a parturient with acute malaria infection: a case report. Korean J Anesthesiol 2016; 69:193-6. [PMID: 27066212 PMCID: PMC4823419 DOI: 10.4097/kjae.2016.69.2.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 05/22/2015] [Accepted: 05/29/2015] [Indexed: 11/23/2022] Open
Abstract
Malaria is associated with high rates of morbidity and mortality worldwide, particularly in Africa, Southeast Asia and South America. Nonetheless, several cases of malaria have been reported in Western countries involving travelers from endemic areas, though very few involve pregnant women. In this article, we report a case of a young woman born in Sierra Leone who had been living in Italy for two years. She was admitted to our hospital with malaise; worsening of her condition led to Plasmodium falciparum infection diagnosis early during her hospital stay, as well as an urgent cesarean delivery. We briefly discuss the features of malaria in pregnancy, the difficulties associated with early diagnosis, and the possible fetal and maternal implications, and also consider how the disease may affect anesthetic management.
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Affiliation(s)
- Bruno Antonio Zanfini
- Department of Anesthesia and Intensive Care Medicine, Catholic University of the Sacred Heart, Policlinico "Gemelli", Roma, Italy
| | - Antonio Maria Dell'Anna
- Department of Anesthesia and Intensive Care Medicine, Catholic University of the Sacred Heart, Policlinico "Gemelli", Roma, Italy
| | - Stefano Catarci
- Department of Anesthesia and Intensive Care Medicine, Catholic University of the Sacred Heart, Policlinico "Gemelli", Roma, Italy
| | - Luciano Frassanito
- Department of Anesthesia and Intensive Care Medicine, Catholic University of the Sacred Heart, Policlinico "Gemelli", Roma, Italy
| | - Salvatore Vagnoni
- Department of Anesthesia and Intensive Care Medicine, Catholic University of the Sacred Heart, Policlinico "Gemelli", Roma, Italy
| | - Gaetano Draisci
- Department of Anesthesia and Intensive Care Medicine, Catholic University of the Sacred Heart, Policlinico "Gemelli", Roma, Italy
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Koopmans LC, van Wolfswinkel ME, Hesselink DA, Hoorn EJ, Koelewijn R, van Hellemond JJ, van Genderen PJJ. Acute kidney injury in imported Plasmodium falciparum malaria. Malar J 2015; 14:523. [PMID: 26702815 PMCID: PMC4690233 DOI: 10.1186/s12936-015-1057-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 12/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a known complication of malaria, and is reported to occur in up to 40% of adult patients with a severe Plasmodium falciparum infection in endemic regions. To gain insight in the incidence and risk factors of AKI in imported P. falciparum malaria, a retrospective analysis was performed on a large cohort of mostly non-immune patients with imported P. falciparum malaria. Aiming to include not only severe but also milder forms of renal failure, the KDIGO criteria were used to define AKI. METHODS Clinical and laboratory data from 485 consecutive cases of imported P. falciparum malaria were extracted from the Rotterdam Malaria Cohort database. Acute kidney injury (AKI) was defined using the KDIGO criteria. Univariate and multivariate logistic regression analyses were used to identify risk factors for AKI. RESULTS AKI was seen in 39 (8%) of all patients and in 23 (38%) of the 61 patients with severe malaria. Eight patients eventually needed renal replacement therapy (RRT); seven of them already had AKI at presentation. Higher age, higher leucocyte count and thrombocytopaenia were independently-associated with AKI but their positive predictive values were relatively poor. CONCLUSION AKI was found to be a common complication in adults with imported P. falciparum necessitating RRT in only a small minority of patients. The use of the KDIGO staging allows early recognition of a decline in renal function.
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Affiliation(s)
- Liese C Koopmans
- Institute for Tropical Diseases, Harbour Hospital, Haringvliet 2, 3011 TD, Rotterdam, The Netherlands.
| | - Marlies E van Wolfswinkel
- Institute for Tropical Diseases, Harbour Hospital, Haringvliet 2, 3011 TD, Rotterdam, The Netherlands. .,Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.
| | - Dennis A Hesselink
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
| | - Ewout J Hoorn
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
| | - Rob Koelewijn
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.
| | - Jaap J van Hellemond
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.
| | - Perry J J van Genderen
- Institute for Tropical Diseases, Harbour Hospital, Haringvliet 2, 3011 TD, Rotterdam, The Netherlands.
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Protective Effects of Tinospora crispa Stem Extract on Renal Damage and Hemolysis during Plasmodium berghei Infection in Mice. J Pathog 2015; 2015:738608. [PMID: 26600953 PMCID: PMC4639667 DOI: 10.1155/2015/738608] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 09/30/2015] [Accepted: 10/13/2015] [Indexed: 01/19/2023] Open
Abstract
Renal damage and hemolysis induced by malaria are associated with mortality in adult patients. It has been speculated that oxidative stress condition induced by malaria infection is involved in its pathology. Thus, we aimed to investigate the protective effects of Tinospora crispa stem extract on renal damage and hemolysis during Plasmodium berghei infection. T. crispa stem extract was prepared using hot water method and used for oral treatment in mice. Groups of ICR mice were infected with 1 × 107 parasitized erythrocytes of P. berghei ANKA by intraperitoneal injection and given the extracts (500, 1000, and 2000 mg/kg) twice a day for 4 consecutive days. To assess renal damage and hemolysis, blood urea nitrogen (BUN), creatinine, and hematocrit (%Hct) levels were then evaluated, respectively. Malaria infection resulted in renal damage and hemolysis as indicated by increasing of BUN and creatinine and decreasing of %Hct, respectively. However, protective effects on renal damage and hemolysis were observed in infected mice treated with these extracts at doses of 1000 and 2000 mg/kg. In conclusion, T. crispa stem extract exerted protective effects on renal damage and hemolysis induced by malaria infection. This plant may work as potential source in the development of variety of herbal formulations for malarial treatment.
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46
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Meremo AJ, Kilonzo SB, Munisi D, Kapinga J, Juma M, Mwanakulya S, Mpondo B. Acute renal failure in a Caucasian traveler with severe malaria: a case report. Clin Case Rep 2014; 2:82-5. [PMID: 25356255 PMCID: PMC4184599 DOI: 10.1002/ccr3.65] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 12/22/2013] [Indexed: 11/09/2022] Open
Abstract
KEY CLINICAL MESSAGE Acute renal failure (ARF) secondary to severe malaria is uncommon. We report a case of a patient visiting Africa for the first time presenting with malaria and ARF. There was complete recovery after hemodialysis. Early initiation of hemodialysis proves to be useful in restoration of renal function.
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Affiliation(s)
- Alfred J Meremo
- Haemodialysis Unit, University of Dodoma Dodoma, Tanzania ; Department of Internal Medicine, College of Health sciences, University of Dodoma Dodoma, Tanzania
| | - Semvua B Kilonzo
- Department of Internal Medicine, Morogoro Regional Referral Hospital Dodoma, Tanzania
| | - David Munisi
- Department of Biomedical sciences, College of Health sciences, University of Dodoma Dodoma, Tanzania
| | - Janet Kapinga
- Haemodialysis Unit, University of Dodoma Dodoma, Tanzania
| | - Mwinyikondo Juma
- Haemodialysis Unit, University of Dodoma Dodoma, Tanzania ; Department of Internal Medicine, College of Health sciences, University of Dodoma Dodoma, Tanzania
| | - Simfukwe Mwanakulya
- Department of Internal Medicine, Morogoro Regional Referral Hospital Dodoma, Tanzania
| | - Bonaventura Mpondo
- Haemodialysis Unit, University of Dodoma Dodoma, Tanzania ; Department of Internal Medicine, College of Health sciences, University of Dodoma Dodoma, Tanzania
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Abstract
Malaria, which is caused by Plasmodium parasite erythrocyte infection, is a highly inflammatory disease with characteristic periodic fevers caused by the synchronous rupture of infected erythrocytes to release daughter parasites. Despite the importance of inflammation in the pathology and mortality induced by malaria, the parasite-derived factors inducing the inflammatory response are still not well characterized. Uric acid is emerging as a central inflammatory molecule in malaria. Not only is uric acid found in the precipitated form in infected erythrocytes, but high concentrations of hypoxanthine, a precursor for uric acid, also accumulate in infected erythrocytes. Both are released upon infected erythrocyte rupture into the circulation where hypoxanthine would be converted into uric acid and precipitated uric acid would encounter immune cells. Uric acid is an important contributor to inflammatory cytokine secretion, dendritic cell and T cell responses induced by Plasmodium, suggesting uric acid as a novel molecular target for anti-inflammatory therapies in malaria.
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Marks M, Gupta-Wright A, Doherty JF, Singer M, Walker D. Managing malaria in the intensive care unit. Br J Anaesth 2014; 113:910-21. [PMID: 24946778 PMCID: PMC4235570 DOI: 10.1093/bja/aeu157] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The number of people travelling to malaria-endemic countries continues to increase, and malaria remains the commonest cause of serious imported infection in non-endemic areas. Severe malaria, mostly caused by Plasmodium falciparum, often requires intensive care unit (ICU) admission and can be complicated by cerebral malaria, respiratory distress, acute kidney injury, bleeding complications, and co-infection. The mortality from imported malaria remains significant. This article reviews the manifestations, complications and principles of management of severe malaria as relevant to critical care clinicians, incorporating recent studies of anti-malarial and adjunctive treatment. Effective management of severe malaria includes prompt diagnosis and early institution of effective anti-malarial therapy, recognition of complications, and appropriate supportive management in an ICU. All cases should be discussed with a specialist unit and transfer of the patient considered.
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Affiliation(s)
- M Marks
- The Hospital for Tropical Diseases, Mortimer Market Centre, Capper Street, London, UK Department of Clinical Research, Faculty of Infectious and Tropical Diseases London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - A Gupta-Wright
- The Hospital for Tropical Diseases, Mortimer Market Centre, Capper Street, London, UK Department of Clinical Research, Faculty of Infectious and Tropical Diseases London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - J F Doherty
- The Hospital for Tropical Diseases, Mortimer Market Centre, Capper Street, London, UK
| | - M Singer
- Department of Critical Care, University College London Hospital NHS Foundation Trust, 3rd Floor, 235 Euston Road, London NW1 2BU, UK
| | - D Walker
- Department of Critical Care, University College London Hospital NHS Foundation Trust, 3rd Floor, 235 Euston Road, London NW1 2BU, UK
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Wichapoon B, Punsawad C, Chaisri U, Viriyavejakul P. Glomerular changes and alterations of zonula occludens-1 in the kidneys of Plasmodium falciparum malaria patients. Malar J 2014; 13:176. [PMID: 24884882 PMCID: PMC4023169 DOI: 10.1186/1475-2875-13-176] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 04/29/2014] [Indexed: 11/10/2022] Open
Abstract
Background The process of cytoadhesion in Plasmodium falciparum malaria infection causes signaling processes that lead to structural and functional changes at the cellular level. Histopathological changes of acute kidney injury (AKI) in P. falciparum malaria often involve glomerular proliferation, thickening of the glomerular basement membrane, acute tubular necrosis, and interstitial inflammation. Focusing on the glomeruli, this study aimed to investigate glomerular and tight junction-associated protein- zonula occludens-1 (ZO-1) changes in P. falciparum malaria patients. Methods Kidney tissues were grouped into P. falciparum with AKI (Cr ≥ 265 μmol/L or 3 mg/dl), P. falciparum without AKI (Cr < 265 μmol/L), and normal kidney tissues (control group). Glomerular cells and the glomerular area were quantified and compared in three experimental groups. The tight junction was investigated immunohistochemically using tight junction-associated protein, ZO-1, protein marker. A further immunofluorescence study was performed in an endothelial cell (EC)-parasitized red blood cell (PRBC) co-culture system, to evaluate the tight junction protein. Results Glomerular cell proliferation was significant in P. falciparum with AKI (Cr ≥ 265 μmol/L). By contrast, the glomerular area decreased significantly. ZO-1 expression was significantly decreased in the AKI group compared with normal kidneys, and in kidney tissues without AKI (p < 0.05). This was further confirmed by the depletion in ZO-1 localization in ECs co-cultured with PRBCs. Conclusions In P. falciparum malaria with AKI, the decrease in glomerular area, despite glomerular cell proliferation, could be due to the collapse of cellular structures secondary to damaged tight junction-associated protein, ZO-1.
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Affiliation(s)
| | | | | | - Parnpen Viriyavejakul
- Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand.
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Punsawad C, Viriyavejakul P. Nuclear factor kappa B in urine sediment: a useful indicator to detect acute kidney injury in Plasmodium falciparum malaria. Malar J 2014; 13:84. [PMID: 24607031 PMCID: PMC3984725 DOI: 10.1186/1475-2875-13-84] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 03/02/2014] [Indexed: 01/09/2023] Open
Abstract
Background Acute kidney injury (AKI) is one of the major complications of Plasmodium falciparum malaria, especially among non-immune adults. It has recently been revealed that activation of transcription factor nuclear factor kappa B (NF-κB) induces pro-inflammatory gene expression involved in the development of progressive renal inflammatory diseases. The aim of this study was to determine whether urinary sediment NF-κB p65 can act as a biomarker for AKI in patients with P. falciparum malaria. Methods Urinary sediments from malaria patients, including Plasmodium vivax malaria, uncomplicated P. falciparum malaria, complicated P. falciparum malaria without AKI (serum creatinine-Cr <3 mg/dl) and complicated P. falciparum malaria with AKI (Cr ≥3 mg/dl) were used to determine NF-κB p65 level by sandwich enzyme-linked immunosorbent assay (ELISA). Urinary sediments obtained from healthy controls were used as a normal baseline. Correlations between levels of urinary sediment NF-κB p65 and pertinent clinical data were analysed. Results Urinary sediment NF-κB p65 levels were significantly increased on the day of admission (day 0) and on day 7 post-treatment in complicated P. falciparum malaria patients with AKI, compared with those without AKI (p = 0.001, p <0.001, respectively), P. vivax patients (all p <0.001) and healthy controls (all p <0.001). NF-κB p65 levels in urinary sediment cells showed a significant positive correlation with serum Cr (Day 0: rs = 0.792; p <0.001, Day 7: rs = 0.605; p <0.001) and blood urea nitrogen (BUN) (Day 0: rs = 0.839; p <0.001, Day 7: rs = 0.596; p <0.001). Conclusions Urinary sediment NF-κB p65 level is a useful indicator for estimating renal tubular epithelial cell damage and subsequent development of AKI among patients with P. falciparum malaria.
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Affiliation(s)
| | - Parnpen Viriyavejakul
- Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, Thailand.
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