Title: Diagnostic & Prognostic Evaluation of Urinary Abnormalities for Malaria Associated Kidney Disease
Authors: Dr Samir Govil, Dr Parag Chandra, Dr Richa Giri
DOI: https://dx.doi.org/10.18535/jmscr/v7i9.127
Abstract
Background: Malaria is a multi-organ illness due to plasmodium species and involves the brain, liver and kidneys1. Urinary abnormalities are frequently found in malaria patients and may be associated with a wide spectrum of renal injury including chronic kidney disease7.
Objective: To correlate urinary abnormalities in malaria patients with the occurrence of kidney disease and its clinical outcomes.
Methods: A prospective study was conducted in 458 patients of confirmed malaria, to measure urinary abnormalities including proteinuria and hematuria at presentation, and correlate them with kidney injury reflected by a falling creatinine clearance rate <60 mg/m2. Patients were treated using standard care pathways and followed for 6 months after discharge from hospital. Persistence or resolution of kidney injury was identified using the parameters mentioned above. Statistical analyses were done using standard tests and a ‘p’ value <0.05 was considered significant.
Results: Urinary abnormalities were found in 230 of 458 (50.21%) patients, and were equally divided between both plasmodium species. Older patients (age>30 years) were more frequently affected, and there wer no gender difference in urinary abnormalities in either species infestation. The average number of dialysis sessions was also similar, while hospital length of stay was significantly greater at 7.29+/-2.94 days in the P. falciparum patients vs. 6.18+/-3.11 days for P. vivax (p<0.05. 198/230). 198 patients survived and 6 months follow up was completed in 142 patients. Complete resolution of kidney disease occurred in 70/142 patients, while 72/142 had residual disease progressing to chronic kidney disease (CKD). There was a significant correlation between urinary abnormalities in malaria patients and renal disease at follow up (p<0.05), which had a negative predictive value of 57.98% with a sensitivity of 20.22% and specificity 69.50%.
Conclusion: Presence and persistence of urinary abnormalities in patients with malaria may be early markers of renal injury. Absence of these urinary abnormalities at follow up suggests resolution of renal insult associated with malaria and low likelihood of progression to CKD.
Keywords: urinary abnormalities, kidney disease, and malaria.
