Renal Complications of Benign Tertian Malaria: A Case-control Study from South Delhi, India

Introduction: Plasmodium vivax (P. vivax) malaria is a major public health problem worldwide, particularly in the tropical and subtropical regions. Although P. vivax malaria is generally considered less severe than Plasmodium falciparum (P. falciparum) malaria, it can still cause severe illness, including severe anaemia, respiratory distress, and cerebral malaria, which can be fatal. Additionally, due to its relapsing nature it can further complicate treatment. Despite being a significant cause of morbidity and mortality, P. vivax malaria has received relatively less attention than P. falciparum malaria. Therefore, this study was designed to evaluate renal complications. Aim: To study the prevalence of renal involvement and its associations with clinical manifestations, laboratory parameters, and other complications in monoinfection of P. vivax malaria. Materials and Methods: This was a retrospective case-control study done over three years duration between April 2017 to March 2020. A total of 380 patients data were taken from hospital records of Hakeem Abdul Hameed Centenary (HAHC) hospital admitted with a diagnosis of P. vivax infection. Renal complications were assessed in all patients admitted with the diagnosis of P. vivax. Renal involvement was defined as per Acute Kidney Injury Network ( AKIN) criteria for Acute Kidney Injury (AKI). For statistical calculations, data was analysed into two groups i.e., AKI and non AKI. Clinical, laboratory and other complications were assessed for statistical significance by t-test/ Mann-Whitney test and for correlation between AKI and these variables univariate analysis was done initially followed by multivariate analysis. Results: In this study, male: female=1.8: 1. The prevalence of AKI was 22.59% with a male: female=2.1:1. Mean age in the AKI group was 35.89 +/- 14.69 years as compared to the non AKI group was 29.40 +/- 12.44 years (p-value=0.019). Renal involvement was significantly associated with rising hepatic transaminases (p-value=0.02, 0.018 for each variable). Leukopenia was protective for AKI; however rising leukocyte count was associated with increasing odds of renal involvement with Odd Ratio (OR) of 7.486 (p-value=0.001). AKI was strongly associated with increasing age, leukocytosis, and hyperbilirubinaemia. Whereas hepatic transaminases, hyponatraemia, cerebral malaria, acute respiratory distress syndrome, and thrombocytopaenia were weakly associated with AKI. Conclusion: P. vivax is not benign malaria anymore; complications should be anticipated and treated at an early stage.