Plasmodium vivax malaria complicated by acute kidney injury: experience at a referral hospital in Uttarakhand, India.

Background: Acute kidney injury (AKI) is a serious complication of Plasmodium vivax malaria, worsening its prognosis.

Methods: This prospective study assessed the incidence, clinical spectrum, prognostic factors and outcome of AKI in P. vivax malaria. During 2010-2011, 195 patients with vivax malaria diagnosed by positive peripheral blood film and rapid malaria test were studied for AKI using RIFLE criteria.

Results: AKI occurred in 63 patients (32%), with maximum RIFLE class R (Risk), class I (Injury) and class F (Failure) in 27 (43%), 23 (37%) and 13 (21%) patients, respectively. AKI was associated with oliguria/anuria (48%), anaemia (70%), thrombocytopenia (84%), hepatic dysfunction (48%), gastrointestinal manifestations (33%), acute respiratory distress syndrome (ARDS) (14%), cerebral malaria (6%), disseminated intravascular coagulation (8%) and shock (11%). All 63 patients with AKI received artesunate and 12 (19%) received quinine after failure of response to artesunate. Fourteen patients (22%) underwent haemodialysis. Patients with maximum RIFLE class R, I and F had mortality rates of 3.7%, 4.3% and 30.7%, respectively. Poor prognostic factors were delayed diagnosis, anaemia, severe AKI, shock, ARDS, need for ventilatory support, raised serum transaminases and metabolic acidosis.

Conclusions: AKI is now common in vivax malaria and has significant mortality. Its early recognition and management can improve the outcome.