Spectrum of clinical and biochemical profile in children with malarial nephropathy

ORIGINAL ARTICLE

Spectrum of Clinical and Biochemical Profile in Children with Malarial Nephropathy

Subal Ku. Pradhan, Pawan Mutalik, Dolamani Tandi, Leena Das, Saroj Ku. Satpathy.

Department of Pediatrics, Sardar Vallabh Bhai Patel Post Graduate Institute of Pediatrics (SVPPGIP) and SCB Medical College, Cuttack, Odisha, India.

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Abstract
Aim: To assess the factors, clinical presentations and complications associated with malarial nephropathy.
Methods: This prospective study was conducted in the period from July 2009 to January 2013 and included malarial children with nephropathy, aged between 6 months to 14 years. Malaria was confirmed by microscopic examination of blood smear. Detailed clinical evaluation and investigations were carried out to find multi-organ afflictions with special emphasis on renal involvement. Acute Kidney Injury (AKI) staging was done as per Acute Kidney Injury Network Staging into three groups which is modified RIFLE (Risk, Injury, Failure, Loss, End stage renal disease) staging.
Results: Out of 168 cases with malaria, 82 (48.8%) cases had nephropathy. One hundred and two (60.7%) were between 5-10 years age group. Renal involvement was seen with P. falciparum malaria in 58 (48.3%) patients. Oligo-anuria was present in 48 (58.5%) cases and generalized edema was present in 27 (32.9%) cases at the onset. Proteinuria was present in 66 (80.5%) cases. Hyponatremia was seen in 29 (35.3%) patients. Twenty (62.5%) cases presented in Stage III of AKI, 9 (28.1%) in stage II and remaining 3 (9.4%) cases in stage I. Fourteen cases (17.1%) were treated with peritoneal dialysis and six cases were shifted to hemodialysis unit requiring prolonged renal supportive care. Of them, thirteen cases had P. falciparum malaria. Sixteen patients out of 168 cases (9.5%) died. Nine children out of 16 (56.2%) who died were associated with malarial nephropathy of which seven cases (77.7%) had Stage III AKI among which 5 (71.4%) children had P. falciparum malaria and remaining cases had mixed infection.
Conclusion: The spectrum of malarial nephropathy in children is highly variable ranging from asymptomatic proteinuria to advanced stage of AKI. Renal involvement is more common and severe in P.falciparum. Children aged between 5-10 years along with oligo-anuria, symptomatic azotemia, electrolyte abnormalities and hepatopathy are more likely to develop advanced stage AKI and subsequently have an increased risk of mortality.

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