Publication: Correlation of biomarkers for parasite burden and immune activation with acute kidney injury in severe falciparum malaria
Issued Date
2014
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Language
eng
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Mahidol University
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BioMed Central
Bibliographic Citation
Malaria Journal. Vol.13, (2014), 91
Suggested Citation
Katherine Plewes, Royakkers, Annick A, Josh Hanson, Md Mahtab Uddin Hasan, Shamsul Alam, Aniruddha Ghose, Maude, Richard J, Stassen, Pauline M, Prakaykaew Charunwatthana, Lee, Sue J, Turner, Gareth DH, Dondorp, Arjen M, Schultz, Marcus J Correlation of biomarkers for parasite burden and immune activation with acute kidney injury in severe falciparum malaria. Malaria Journal. Vol.13, (2014), 91. Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/3071
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Title
Correlation of biomarkers for parasite burden and immune activation with acute kidney injury in severe falciparum malaria
Abstract
Background: Acute kidney injury (AKI) complicating severe Plasmodium falciparum malaria occurs in up to 40% of
adult patients. The case fatality rate reaches 75% in the absence of renal replacement therapy (RRT). The precise
pathophysiology of AKI in falciparum malaria remains unclear. Histopathology shows acute tubular necrosis with
localization of host monocytes and parasitized red blood cells in the microvasculature. This study explored the
relationship of plasma soluble urokinase-type plasminogen activator receptor (suPAR), as a proxy-measure of
mononuclear cell activation, and plasma P. falciparum histidine rich protein 2 (PfHRP2), as a measure of sequestered
parasite burden, with AKI in severe malaria.
Methods: Admission plasma suPAR and PfHRP2 concentrations were assessed in Bangladeshi adults with severe
falciparum malaria (n = 137). Patients were stratified according to AKI severity based on admission creatinine
clearance.
Results: A total of 106 (77%) patients had AKI; 32 (23%), 42 (31%) and 32 (23%) were classified into ‘mild, ‘moderate’
and ‘severe’ AKI groups, respectively. Plasma suPAR and PfHRP2 concentrations increased with AKI severity (test-fortrend
P <0.0001) and correlated with other markers of renal dysfunction. Admission plasma suPAR and PfHRP2
concentrations were higher in patients who later required RRT (P <0.0001 and P = 0.0004, respectively). In a
multivariate analysis, both increasing suPAR and PfHRP2 were independently associated with increasing urine
neutrophil gelatinase-associated lipocalin concentration, a marker of acute tubular necrosis (β = 16.54 (95% CI 6.36-
26.71) and β = 0.07 (0.02-0.11), respectively).
Conclusions: Both sequestered parasite burden and immune activation contribute to the pathogenesis of AKI in
severe falciparum malaria.