By Gift Briton

With acute kidney injury (AKI), an emerging public health concern causing suffering and death in almost 6 out of 10 African children having severe malaria, more action is needed to alleviate this suffering.

AKI is a kidney complication mostly common in critically ill children and is characterized by increase in serum creatinine levels (increase of waste products that comes from the bloodstream) and decrease in urine output, according to Dr Nancy Odundo, Nephrologist at Kenyatta National Hospital(KNH).

The disease is increasingly causing death and morbidity among children, however, a lot of challenges exist in defining and managing AKI in children with severe malaria in low and middle income countries, particularly in sub-Saharan Africa, due to shortage of nephrologists and laboratory capacity in the region.

“Limitations in laboratory infrastructure in sub-Saharan Africa impacts the ability to assess AKI in clinical settings where access to specialized diagnostic tests often relies on out-of-pocket payment by patients. Therefore, affordable and accessible diagnostics are critical to improving diagnosis and clinical management of AKI,” the International Journal of Nephrology and Renovascular Disease 2021 report reads.

According to Dr Odundo, severe malaria associated with acute kidney disease is caused by loss of body fluids, medications and chemicals that rapidly deteriorate the kidney function, parasite sequestration, rapture of blood cells and immune action among others.

Moreover, she notes that the diseases can also lead to a prolonged stay in the Pediatric Intensive Care Unit(PICU), hypertension, increased long term risk of neurocognitive impairment and behavioral problems in survivors.

Therefore, for the diagnosis of AKI in low and middle income setting, Dr. Odundo notes that clinicians should constantly monitor body weight, lung sound, fluid intake, urine and stool output, and vital signs in high-risk patients, measuring drug levels and if possible, adjusting them accordingly.

She adds that it also important to reduce additional risk factors such as nephrotoxic agents, if possible. With no effective medications for established AKI, Dr. Odundo says that prevention and early detection are therefore the mainstays of its management and improving outcomes.

The disease is grouped into four stages based on the amplitude of serum creatinine elevation from the baseline value including the first stage (Risk), followed by Injury stage, Failure (third stage), Loss(fourth) and the last stage (End-Stage Renal Disease).

The risk stage is characterized by 25 percent decrease of the urine output, the injury stage is characterized by 50 percent reduction in the urine output, 75 percent decrease indicate a kidney failure stage, a persistent renal failure for more than four weeks indicate a loss stage and the end stage marked by a persistent renal failure of more than three months.

According to Dr Odundo, countries need to prioritize on research to improve the detection, diagnosis, and clinical management of AKI in children with severe malaria since long-term consequences of AKI in children with severe malaria remain understudied in the region. Moreover, to understand the long-term impact of AKI, additional research is needed to improve access to affordable and quality diagnostics to facilitate the early identification of AKI.

In addition, clear and context-specific clinical guidelines are urgently needed that can be adapted and applied in resource-constrained rural clinics and well-resourced intensive care units at public and private health facilities.