Unique aspects of acute kidney injury associated with infections in the tropics: presentation, challenges, and opportunities

Abstract

“The tropics” currently account for around 40% of the world's population and face unique environmental challenges, with limited resources, a deficient health system, and a rudimentary sanitary infrastructure, in addition to a lack of adequate preventive measures and poor surveillance programs. Cases of acute kidney injury in the tropics are to a very large extent driven by infections such as leptospirosis, scrub typhus, dengue, malaria, Ebola virus, yellow fever, and HIV, with a pathogenesis driven by volume depletion, hypotension, and immune-mediated mechanisms. Many of these infections also lead to multiorgan failure and significant morbidity and mortality. Delayed diagnosis and limited access to kidney replacement therapy can further worsen the prognosis. Investment in preventive measures such as vector control, clean water access, robust vaccination programs, and health system strengthening is vital to reduce the incidence and severity of infection-associated acute kidney injury in the tropics.