Malaria and Kidney

Abstract

Malaria is a parasitic disease of great
epidemiological importance in the tropics.
Plasmodium falciparum and Plasmodium malariae
infection can lead to clinically significant renal
diseases. In general, the former is an acute
complication (acute tubular necrosis and
glomerulonephritis), while malariae infection can be
associated with a chronic progressive syndrome
(nephrotic syndrome with evolution to chronic renal failure).
It appears that acute renal failure (ARF) in
falciparum malariae cases is not directly caused by
the parasite itself, but is the result of interaction of
mechanical, immunological, and humoral
components. Risk factors for the development of
renal failure include hyper-parasitaemia, shock and
severe intravascular haemolysis. Delayed treatment
of malaria and late or inadequate correction of
volume depletion, are probable contributing factors
in some cases. The reversibility of the renal lesion
has been well shown, by the reduction in mortality
achieved by introducing peritoneal or hemodialysis,
as well as following the parenteral administration of
quinine. In severe cases associated with “black water
fever” a fatal outcome is almost inevitable.
A mild acute glomerulonephrits has been
documented in many patients with acute falciparum malaria.
The nephrotic syndrome may develop in patients,
particularly children with repeated plasmodium
malariae infections. It seems that this entity results
from chronic deposition of immune complexes in the kidney.