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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2017  |  Volume : 28  |  Issue : 3  |  Page : 667-669
Dengue and acute kidney injury: A need for aggressive maneuvers


1 Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang; Chronic Kidney Disease Resource Center, School of Medical Sciences, Health Campus, University Sains Malaysia, Kubang Kerain, Kelantan, Malaysia
2 Chronic Kidney Disease Resource Center, School of Medical Sciences, Health Campus, University Sains Malaysia, Kubang Kerain, Kelantan, Malaysia
3 Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia

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Date of Web Publication18-May-2017
 

How to cite this article:
Mallhi TH, Khan AH, Khan YH, Adnan AS, Sarriff A. Dengue and acute kidney injury: A need for aggressive maneuvers. Saudi J Kidney Dis Transpl 2017;28:667-9

How to cite this URL:
Mallhi TH, Khan AH, Khan YH, Adnan AS, Sarriff A. Dengue and acute kidney injury: A need for aggressive maneuvers. Saudi J Kidney Dis Transpl [serial online] 2017 [cited 2021 Mar 6];28:667-9. Available from: https://www.sjkdt.org/text.asp?2017/28/3/667/206453
To the Editor,

Recently, we came across a letter to the editor entitled “Dengue nephropathy: Immunopatho- logy and Immune complex involvement” by Wiwanitkit, published in your prestigious journal (Saudi J Kidney Dis Transpl 2016; 27(6): 1280–2).[1] We appreciate the author’s contribution to underscore the attention of health-care professions towards dengue-induced nephropathies, a highly neglected and least appreciated area in dengue research. The author has described the prevalence and mortality rate of acute kidney injury (AKI) among dengue patients and emphasized the immuno- logical mechanisms attributed to the renal complications during dengue infection. Although the author provided sufficient information to alert health authorities about this neglected area, but he missed some important points that we believe should be addressed while discussing dengue-induced nephropathies.

In our recent investigations, AKI was observed in 14.2% of patients with dengue fever and was accompanied by high morbidity and mortality. Moreover, dengue patients with AKI had prolonged hospital stay as compared to those having no AKI. We also observed that patients who were admitted late to the hospital had high odds of AKI and portended high disease severity.[2],[3],[4],[5] Such high morbidity, mortality, and prolonged hospitalization due to dengue-associated AKI imposes a substantial economic burden on patients and health-care system, and it is of particular importance in dengue-endemic regions. Unfortunately, there is no consensus to define AKI in dengue infection that leads to wide variations in incidence and characteristics of dengue-induced AKI. In a separate series, we classified AKI among dengue patients by using three commonly used definitions and found considerable differences in incidence, clinico-laboratory characteristics, and predictive model by using different criteria of AKI.[6] Use of several criteria causes a great disparity in literature that makes it difficult or even impossible to compare the results across studies. Therefore, a consensual criterion is needed to classify AKI among dengue patients. Furthermore, recovery of renal function among AKI survivors has not been evaluated, and there is high propensity that these patients may develop chronic renal abnormalities in future.[7] We suggest prospective follow-up studies to ascertain the post-AKI epidemiology in dengue infection. In addition, consensus to define renal recovery in dengue infection needs attention.

AKI is highly morbid with fatal intricacy in dengue viral infection and is associated with prolonged hospitalization and high cost. Currently, there are no specific recommendations regarding treatment, either conservative or with dialysis in patients with dengue having AKI as well as, the quality of life and survival. There is a dire need for more research relating to etiopathogenesis and the best therapeutic approach for dengue-induced AKI.

Conflict of interest: None declared.

 
   References Top

1.
Wiwanitkit V. Dengue nephropathy: Immuno- pathology and immune complexinvolvement. Saudi J Kidney Dis Transpl 2016;27:1280-2.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Mallhi TH, Khan AH, Adnan AS, Sarriff A, Khan YH, Jummaat F. Incidence, Characteristics and risk factors of acute kidney injury among dengue patients: A retrospective analysis. PLoS One 2015;10:e0138465.  Back to cited text no. 2
[PUBMED]    
3.
Mallhi TH, Khan AH, Adnan AS, et al. Clinico-laboratory spectrum of dengue viral infection and risk factors associated with dengue hemorrhagic fever: A retrospective study. BMC Infect Dis 2015;15:399.  Back to cited text no. 3
    
4.
Mallhi TH, Khan AH, Sarriff A, Adnan AS, Khan YH. Patients related diagnostic delay in dengue: An important cause of morbidity and mortality. Clin Epidemiol Glob Health 2016; 4:200-1.  Back to cited text no. 4
    
5.
Mallhi TH, Khan AH, Sarriff A, Adnan AS, Khan YH. Association of ward acquired, on- admission, progressive and non-progressive AKI with death among dengue patients: A hidden relationship. Acta Med Port 2016;29: 157-8.  Back to cited text no. 5
[PUBMED]    
6.
Mallhi TH, Khan AH, Sarriff A, Adnan AS, Khan YH, Jummaat F. Defining acute kidney injury in dengue viral infection by conventional and novel classification systems (AKIN and RIFLE): A comparative analysis. Postgrad Med J 2016;92:78-86.  Back to cited text no. 6
[PUBMED]    
7.
Mallhi TH, Khan AH, Sarriff A, Adnan AS, Khan YH. Renal recovery after dengue induced acute kidney injury (DAKI): A future perspective. Clin Queries Nephrol 2016;5:40- 1.  Back to cited text no. 7
    

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Correspondence Address:
Dr. Tauqeer Hussain Mallhi
Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang; Chronic Kidney Disease Resource Center, School of Medical Sciences, Health Campus, University Sains Malaysia, Kubang Kerain, Kelantan
Malaysia
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DOI: 10.4103/1319-2442.206453

PMID: 28540914

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