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| Year : 2010 | Volume
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| Issue : 1 | Page : 153-154 |
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| Acute tubular necrosis, acute renal failure and unusual histologic stigmata of acute malaria in HIV/AIDS patients from the democratic Republic of Congo |
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Nestor M Pakasa
Department of Pathology, University Hospital of Kinshasa, Democratic Republic of Congo, Congo
Click here for correspondence address and email
| Date of Web Publication | 8-Jan-2010 |
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How to cite this article:
Pakasa NM. Acute tubular necrosis, acute renal failure and unusual histologic stigmata of acute malaria in HIV/AIDS patients from the democratic Republic of Congo. Saudi J Kidney Dis Transpl 2010;21:153-4 |
How to cite this URL:
Pakasa NM. Acute tubular necrosis, acute renal failure and unusual histologic stigmata of acute malaria in HIV/AIDS patients from the democratic Republic of Congo. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2021 Jul 24];21:153-4. Available from: https://www.sjkdt.org/text.asp?2010/21/1/153/58793 |
To the Editor,
A screening of 43 pre and post-mortem renal specimens from HIV-1/AIDS infected patients "incidentally" revealed unusual presence of stigmata of acute malaria in five male and seven female (28%). The twelve patients were all hypotensive and had a depressed renal function (mean serum creatinine 10.7 ± 3.1 mg/dL; BUN 198.2 ± 56.4 mg/dL). 4 had pitting edema. A single patient had nephrotic range proteinuria and another had microscopic hematuria. On histologic examination of renal specimens, besides huge amount of malarial material including free merozoites clogging capillary luminae and in tubules, [1],[2] there was also severe acute tubular necrosis (ATN) [Figure 1]A and B in 10 (85%) patients. 2 of these patients had a classical HIV-associated nephropathy (HIVAN), 1 had a hilar focal and segmental sclerosis, 1 had a global sclerosis, 4 had mesangial hyperplasia [Figure 1]A and 1 had amyloidosis. All patients died within 5.1 ± 2.1 days from various complications. The synergism of malaria and HIV/ AIDS has not sparked much attention in developing sub-Saharan countries. A study from Zimbabwe showed that HIV infection was significantly associated with development of severe and complicated malaria. [3] Acute renal failure (ARF) occurred in 1.2% cases. A prospective clinical survey of 210 HIV-seropositive patients from our hospital found ARF in 24 of them (11.4%) and 16% were associated with malaria. The outcome was poor and 91.6% died very shortly after admission. [4] Another unpublished study from the same department disclosed 36.8% of ARF to be associated with acute malaria. In poor countries like the Democratic Republic of Congo lacking any renal replacement modalities, [5] preventable severe malaria per se may contribute to the high mortality from severe ATN-induced ARF. Simultaneous occurrence of both hyperacute malaria and HIV/AIDS may decrease the chances of survival.
In conclusion, we have documented overwhelming morphologic evidence of malaria related renal disease superimposed on and exacerbating renal failure in HIV/AIDS cohorts. A high index of suspicion may improve renal and overall survival in such patients.
 References | |  |
| 1. | Pakasa M, Vandamme B, Desmet VJ. Free intraglomerular antigens in experimental malaria. Br J Exp Pathol 1985;66:493-501.  |
| 2. | Vandamme B, Pakasa M, Desmet VJ. Concepts in the Pathogenesis of malaria nephropathy. Recent advances in pediatric nephrology 1987; 287-292. Elsevier Science Publishers B.V.K. Karakam et al. editors. |
| 3. | Chirenda J, Siziya S, Tshimanga M. Association of HIV infection with the development of severe and complicated malaria cases at a rural hospital in Zimbabwe. Cent Afr J Med 2000; 46:5-9. [PUBMED] [FULLTEXT] |
| 4. | Nyimi ML, Lepira FB, Sumaili KE, Ebengo BC, Nseka MN, Longo-Mbenza B. Acute renal failure associated with HIV infection. A report of 24 cases. Louvain Medical 2001;120:167-72. |
| 5. | Pakasa N, Sumaili E. The nephrotic syndrome in the Republic Democratic of Congo. N Engl J Med 2006;354:1085-6. |
Correspondence Address:
Nestor M Pakasa
Department of Pathology, University Hospital of Kinshasa, Democratic Republic of Congo
Congo
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PMID: 20061713 
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| This article has been cited by | | 1 |
Acute renal failure in Congolese children: A tertiary institution experience |
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| Aloni, M.N. and Nsibu, C.N. and Meeko-Mimaniye, M. and Ekulu, P.M. and Bodi, J.M. | | Acta Paediatrica, International Journal of Paediatrics. 2012; 101(11): e514-e518 | | [Pubmed] | | | 2 |
Pathological peculiarities of chronic kidney disease in patient from sub-Saharan Africa. Review of data from the Democratic republic of Congo [Particularités anatomopathologiques de la maladie rénale du sujet de læAfrique sub-Saharienne: Revue synthétique des données de la République démocratique du Congo] |
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| Pakasa, N.-M. and Sumaïli, E.-K. | | Annales de Pathologie. 2012; 32(1): 40-52 | | [Pubmed] | |
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