RENAL FUNCTION IN ACUTE UNCOMPLICATED FALCIPARUM MALARIA IN AFRICAN CHILDREN ON ARTEMETHER-LUMEFANTRINE AND ARTESUNATEAMODIAQUINE COMBINATIONS

Abstract

Objectives: This study explored the effects of acute uncomplicated falciparum malaria on renal
function of patients on both co-formulated and co-packaged artemisinin-based antimalarial therapy.
Materials and methods: The renal function of 43 children with acute uncomplicated falciparum
malaria who had been treated with artemisinin-lumefantrine or artesunate-amodiaquine was
assessed. Glomerular and tubular functions were determined using endogenous creatinine clearance
(eCCl), fractional excretion of sodium (FENa) and potassium (FEK), renal failure index (RFI),
plasma and urine electrolyte analyses and urinalysis. Measurements were done during the acute
illness and on days 28 and 42 after recovery. Associations were explored with t-test, Spearman’s
correlation coefficient and χ2 as appropriate.
Results: Mean eCCl was similar during the acute illness and on days 28 and 42 after recovery (62.4
(48.9 v 67.7 (50.6) ml/min/1.73m2, P=0.73]. In 42% children eCCl was reduced (<50ml/min/1.73m2)
during the acute illness but normalised after recovery in 72.2% of them. There was no correlation
between eCCl and peripheral parasite density (r=0.1, P=0.88). Incipient acute tubular dysfunction
(ATD) was present in 9.3% of the children. RFI revealed anuric with hyperkalaemia (2.3%), oliguric
(4.7%) and non-oliguric (2.3%) ATDs. RFI in 33.6% of children with impaired eCCl during acute
illness were <1.0 which suggested pre-renal causes. Hyponatraemia occurred in 53.4%) of children
during acute illness. Hyponatraemia was higher during than after recovery (53.4% v 23.3 v 27.9%,
P=0.006). Hypokalaemia did not differ significantly (16.3%) during the acute illness and (7.0%)
after recovery (P=0.057). FENa was raised in 28% during the acute illness and continuing sodium
wastage occurred in 14% and 9.3% on days 28 and 42 respectively. FEK was similar during the
acute illness and after recovery (P= 0.06). FENa and FEK were positively correlated during the
illness (r=0.90, P=0.001) and on day 28(r=0.90, P<0.0001) and day 42 (r=0.96, P=<0.0001). Urine
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sodium: potassium ratios were similar during and after recovery and were related to FENa. .
Proteinuria (1+ to 2+) occurred in 6.9% with impaired eCCl during acute illness and in 23.3% with
normal creatinine clearance during this period.
Conclusion: there is a mix of pre-renal and intrinsic renal dysfunction observed in about half of the
children with acute uncomplicated falciparummalaria treated with artemisinin-based but this was
transient