Acute interstitial nephritis with podocyte foot-process effacement complicating Plasmodium falciparum infection

• Published in: Malaria Journal
• Main Authors: Patrick J. Gleeson, John A. O’Regan, Teresa McHale, Helen Tuite, Louise Giblin, Donal Reddan
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2019
• Subjects: Malarial acute renal failure (MARF); Acute interstitial nephritis; Minimal change disease (MCD); Podocyte; Severe malaria; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1186/s12936-019-2674-5; https://doaj.org/article/a7dd3312e9d9491d88b1ebdf1aab09ca

Abstract Background Malarial acute renal failure (MARF) is a component of the severe malaria syndrome, and complicates 1–5% of malaria infections. This form of renal failure has not been well characterized by histopathology. Case presentation A 44 year-old male presented to the emergency department with a 5-day history of fever and malaise after returning from Nigeria. A blood film was positive for Plasmodium falciparum. His creatinine was 616 µmol/L coming from a normal baseline of 89 µmol/L. He had a urine protein:creatinine ratio of 346 mg/mmol (4.4 g/L). He required dialysis. A renal biopsy showed acute interstitial nephritis with podocyte foot-process effacement. He was treated with artesunate and his renal function improved. At 1 year follow-up his creatinine had plateaued at 120 µmol/L with persistent low-grade proteinuria. Conclusion Acute interstitial nephritis and podocyte foot-process effacement might be under-recognized lesions in MARF. Studying the mechanisms of MARF could give insight into the immunopathology of severe malaria.