QUESTION

Explain how malaria can cause renal failure?

ANSWER

There are several mechanisms by which malaria can contribute to renal failure, which vary due to the type of malaria. The exact way in which these various effects combine to cause acute renal failure is not known.

The most common type of malaria to cause renal failure is Plasmodium falciparum, generally the most severe and deadly form of the disease. P. falciparum infected red blood cells are known to sequester in tiny red blood cells deep within major organs, including the kidney; it is thought that reduced blood flow and resulting lack of oxygen may contribute to renal failure. Exaggerated immune response to infection may also be a major contributor to renal failure—this is most likely to cause of renal complications seen in other forms of malaria infection, such as Plasmodium malariae infection.

Moreover, acute renal failure is more usually observed in non-immune adults to malaria (such as those who did not grow up in malaria areas) or older children, again suggesting an involvement of the immune response. Finally, dehydration, associated with a lack of sufficient fluid intake during illness with malaria, may compound these other issues, and contribute to renal failure. Perhaps counterintuitively, administration of intravenous fluids may actually worsen the system, due to the body’s shock-like response to the sudden increase in fluids.