A study on outcome of malaria and acute gastroenteritis induced acute kidney injury requiring hemodialysis

Swarna Gupta, Punit Gupta, Vishal Jain


Background: Acute kidney injury previously known as acute renal failure, is characterized by the sudden impairment of kidney function resulting in the retention of nitrogenous and other waste products normally cleared by the kidneys.   Acute Kidney Injury is usually manifested as multiorgan failure syndrome and extracorporeal support may also target fluid overload and heart failure, extracorporeal CO2 removal for combined kidney and lung support, albumin dialysis for liver support. Haemodialysis is more effective than peritoneal dialysis for management of Acute Kidney injury as Peritoneal dialysis is associated with clearance limitation and difficulties with fluid removal and is thus rarely used in adults in developed countries.

Methods: The study was conducted in the Department of Medicine, Pt. J.N.M. Medical College and Dr. B.R.A.M. Hospital, Raipur (CG), India, from 2010 to 2012. All patients of both the sexes who were diagnosed as a case of Acute Kidney Injury due to Acute Gastroenteritis and Malaria and who were advised for Hemodialysis were included in the study. In our study, 32 patients of Acute Kidney Injury were included. The criteria used for AKI in the study was RIFLE criteria. Hemodialysis was done in all the cases. Quantitative variables are reported as means±SD and qualitative variables as percentage. Factor(s) determining outcome of AKI were tested by univariate analysis using “fisher’s exact test”. All variables with a P value <0.05 in the univariate analysis were defined statistically significant.

Results: Out of 32 patients of Acute Kidney Injury in our study, 50% (n=16) were of Malaria associated AKI cases and other 50% (n=16) patients were of Acute Gastroenteritis associated AKI in which 87.5% males,12.5% Females were of Malaria and 75% male,25% Female were in AGE associated AKI. Maximum number of patients presented with features of AKI within first 3days of disease onset i.e. 56.25% (n=9) of malaria patients and 68.75% (n=11) of AGE patients. Mortality due to MOD was more common in Malaria patients as compared to AGE patients. AGE associated AKI patients had different level of deranged SOFA score.

Conclusions: Acute kidney injury due to acute gastroenteritis differs from other causes of AKI by frequent occurrence of hypokalemia. Early diagnosis and prompt management can restore the kidney function.


Acute kidney injury, Acute gastroenteritis, Malaria, SOFA score

Full Text:



Venkataraman R, Kellum JA. Defining acute renal failure: the RIFLE criteria. J Intens Care Med. 2007 Jul;22(4):187-93.

Akcay AA, Turkmen K, Lee W, Edelstein CL. Update on the diagnosis and management. Int J Nephrol Renovasc Dis. 2010;3:129-140.

Waikar SS, Liu KD, Chertow GM. Diagnosis, epidemiology and outcomes of acute kidney injury. Clin J Am Soc Nephrol. 2008;3:844-61.

Yılmaz R, Erdem Y Acute kidney injury in the elderly population. Int Urol Nephrol. 2009;42(1):259-71.

Elsheikha HM, Sheashaa HA. Epidemiology, Pathophysiology, management and outcome of renal dysfunction associated with plasmodia infection. Parasitol Res. 2007;101:1183-90.

Kute VB, Shah PR, Munjappa BC, Gumber MR, Patel HV, Jain SH et al. Outcome and prognostic factors of Malaria associated acute kidney injury requiring hemodialysis: A single centre experience. Indian J Nephrol. 2012;22:33-8.

Khalil P, Murty P. The Patient with Acute kidney injury. Prim Care Clin. 2008:239-64.

Manatsathit S, Dupont HL, Farthing M, Kositchaiwat C, Leelakusolvong S, Ramakrishna BS et al. Guideline for the management of acute diarrhea in adults. J Gastroenterol Hepatol. 2002 Feb 1;17(s1).

Frenzen PD. Mortality due to gastroenteritis of unknown etiology in United States. J Indian Acad Clin Med. 2001;2(3):205-206.

Kellum JA, Srisawat N. Acute Kidney Injury-Definition and Classification. Eur Crit Care Emerg Med. 2010 Jan;2:42-5.

Feest TG, Round A, Hamad S. Incidence of severe acute renal failure in adults: results of a community based study. BMJ. 1993;306(6876):481-3.

Prakash J, Singh AK, Kumar NS, Saxena RK. Acute renal failure in Plasmodium vivax malaria. J Assoc Physicians India. 2003;51:265-7.

Carneiro I, Roca-Feltrer A, Griffin JT, Smith L, Tanner M, Schellenberg JA, Greenwood B, Schellenberg D. Age-patterns of malaria vary with severity, transmission intensity and seasonality in sub-Saharan Africa: a systematic review and pooled analysis. PLOS One. 2010;5(2).

Barsoum RS. Malarial acute renal failure. 2000 J Am Soc Nephrol. 2000;11:2147-54.

Naqvi R, Ahmad E, Akhtar F, Naqvi A, Rizvi A, Sindh Outcome in severe acute renal failure associated with malaria. Nephrol Dial Transplant. 2003;18:1820-3.

Panwar S, Soni RK, Ahmed N. Study of epidemiological profile, clinico-biochemical spectrum and prognosis of malaria induced renal dysfunction in paediatrics age group. Int J Contemp Pediatr 2016;3:91-5.

Wasnik PN, Manohar TP, Humaney NR, Salkar HR. Study of clinical profile of falciparum malaria in a tertiary referral centre in Central India. J Assoc Physicians India. 2012 Oct;60:33-6.

Clermont G, Acker CG, Angus DC, Sirio CA, Pinsky MR, Johnson JP. Renal failure in the ICU: comparison of the impact of acute renal failure and end-stage renal disease on ICU outcomes. Kidney Int. 2002 Sep 1;62(3):986-96.

Liangos O, Wald R, O’Bell JW, Price L, Pereira BJ, Jaber BL. Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol. 2006;1(1):43-51.

Janssens U, Graf C, Graf J, Radke PW, Konigs B, Koch KC et al. Evaluation of the SOFA score: a single-center experience of a medical intensive care unit in 303 consecutive patients with predominantly cardiovascular disorders. Sequential Organ Failure Assessment. Intensive Care Med. 200;26:1037-45.

Anderson R et al. Non-oliguric renal failure. N Eng J Med. 19977;296:1134.

Minuth AN, Terrell JJ, Suki WN. Acute renal failure: a study of the course and prognosis of 104 patients and of the role of furosemide. Am J Med Sci. 1976;271(3):317-24.

Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S et al. Acute renal failure in critically ill patients: a multinational, multicenter study Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators. JAMA. 2005 Aug;294(7):813-8.

Lobo SM, Lobo FR, Lopes-Ferreira F, Bota DP, Melot C, Vincent JL. Initial and delayed onset of acute respiratory failure: factors associated with development and outcome. Anesth Analg. 2006;103(5):1219-23.

Wilairatana P, Westerlund EK, Aursudkij B, Vannaphan S, Krudsood S, Viriyavejakul P et al. Treatment of malarial acute renal failure by hemodialysis. Am J Trop Med Hyg. 1999;60(2):233-7.

Hanson J, Hasan MMU, Royakkers AA, Alam S, Charunwatthana P. Laboratory prediction of the requirement form renal replacement in acute falciparum malaria. Malaria J. 2011;10:217.

Schiffl H, Lang SM, Fischer R. Daily hemodialysis and the outcome of acute renal failure. N Engl J Med. 2002;346 (5):305-10.

Khan RN, Vohra E, Suleman W. Factors determining outcome of acute renal failure patients. J Pak Med Assoc. 2005;55(12):526.

Krishnan A, Karnad DR. Severe Falciparum malaria: An important cause of multiple organ failure in Indian intensive care unit patients. Crit Care Med. 2003;31:2278-84.

Nadkar MY, Huchche AM, Singh R, Pazare AR. Clinical profile of severe Plasmodium vivax malaria in a tertiary care centre in Mumbai from June 2010-January 2011. J Assoc Physicians India. 2012 Oct;60:11-3.