Acute kidney injury among children with severe malaria at St. Francis Hospital Nsambya in Kampala City, Uganda: A retrospective study

Background Acute kidney injury (AKI) is a common complication of severe malaria, arising from multiple pathophysiological processes. AKI is increasingly recognized as a critical contributor to morbidity and mortality in pediatric populations in Sub-Saharan Africa. This study assessed the prevalence of AKI and its associated factors among children diagnosed with severe malaria at St. Francis Hospital Nsambya. Methods This was a retrospective cross-sectional study in which the medical records of 198 children aged 2 months to 12 years admitted between 1 ^st January 2019 and 31 ^st December 2023 were reviewed. AKI was defined using the Kidney Disease Improving Global Outcomes (KDIGO) criteria based on fold change in admission creatinine from estimated baseline. A minimum creatinine value of 0.4mg/dL was required to be considered AKI. Logistic regression analysis was performed to assess factors associated with AKI. A p < 0.05 was considered statistically significant. Results The median (IQR) age of participants was 5 (2–7) years, and the majority were males 130 (65.7%). Overall, 1 in 2 children had AKI (49.5%) with 31.6% (198) participants having stage 3, 24.5% stage 2 AKI, and 15.3% required dialysis. Mortality was confined to children with AKI, with a mortality rate of 4.1% in AKI and highest in stage 3 AKI (9.7%). On multivariable analysis, younger age (aOR 0.6, 95% CI 0.51–0.71), higher BUN (aOR 1.1 per mg/dL, 95% CI 1.03–1.12), and lower hemoglobin levels (aOR 1.3, 95% CI 1.1–1.48) were independently associated with AKI. Conclusion This study found a high prevalence of AKI in children with severe malaria with younger children and children with lower hemoglobin most at risk. Routine early screening and close monitoring of renal function is recommended for all severe malaria cases in hyperendemic areas.