Kidney Week

Abstract: SA-PO1057

Kidney Involvement in Plasmodium falciparum Infection in a Pregnant Patient

Session Information

• Women's Health and Kidney Diseases
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Women's Health and Kidney Diseases

• 2200 Women's Health and Kidney Diseases

Authors

• Vasquez Jiménez, Enzo Christopher, Hospital Juarez de Mexico, Mexico City, Mexico City, Mexico

Enzo Christopher Vasquez Jiménez, MD

• Castillo, Sabrina Vianey, Hospital Juarez de Mexico, Mexico City, Mexico City, Mexico

Sabrina Vianey Castillo

• Soto, Virgilia, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico, Mexico

Virgilia Soto, MD

• Garcia-Flores, Octavio Rene, Hospital Juarez de Mexico, Mexico City, Mexico City, Mexico

Octavio Rene Garcia-Flores, MD

Introduction

In Mexico, cases of malaria are becoming more frequent due to the effects of global warming and the migratory phenomenon. There are various mechanisms that can cause AKI in patients with P. falciparum infection: due to a hemodynamic effect associated with parasitemia, parasite sequestration, endothelial dysfunction, intravascular hemolysis, oxidative stress and immunological damage.

Case Description

A 29-year-old pregnant woman from Equatorial Guinea was admitted with abdominal pain, jaundice and fever, anemia (8.9 g/dL), thrombocytopenia (10x10⁹ /L), hyperbilirubinemia (21 mg/dL), direct bilirubin (15 mg/dL), BUN (21 mg/dl), Cr (0.7 mg/dl). At the time of admission, the patient was 17.5 weeks of pregnancy. Urinalysis showed granular and biliary casts. Diagnosis was confirmed by a thick blood smear and a real-time PCR assay; therefore, antimalarial treatment were started. During stay in the ICU, mechanical ventilation, norepinephrine and CRRT were started due to neurological deterioration, hypotension and severe AKI (creatinine 3.7 mg/dL and anuria). Kidney biopsy was performed due to AKI and a urinary P/C ratio of 4 g/g and revealed an active tubulointerstitial nephritis with acute tubular lesion and pigment tubulopathy with negative IF. Recovery of kidney function was observed and follow-up was carried until the successful resolution of the pregnancy withouth deterioration in kidney function or proteinuria.

Discussion

Malaria is a serious disease in pregnant women. The indications for RRT in pregnant patients with AKI are similar to the general population. However, the thresholds are controversial due to the importance of maintaining an environment without uremia and acidosis to reduce fetal complications. The decision to perform a kidney biopsy in a pregnant patient is less clear and in this case a malaria manifestation was observed. Fortunately, the patient recovered kidney function after specific antimalarial treatment and completed her pregnancy without complications.