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Dengue AKI Multifactorial Mechanisms — ESENeph MCQ

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ModerateAcute Kidney InjuryDengue AKI Multifactorial MechanismsESENeph

A 35-year-old man develops dengue fever with AKI. His creatinine rises to 350 umol/L. He has thrombocytopenia, haemoconcentration, and plasma leakage. What mechanisms cause AKI in dengue?

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Correct answer: A — Multifactorial: haemodynamic instability from plasma leakage (pre-renal), direct viral infection of tubular cells, rhabdomyolysis, haemolysis, and immune complex-mediated GN – AKI occurs in 10-15% of severe dengue; most cases recover with supportive care

Dengue-associated AKI involves multiple mechanisms: (1) pre-renal from hypovolaemia secondary to plasma leakage (hallmark of dengue haemorrhagic fever); (2) direct viral infection of renal tubular and mesangial cells (dengue antigen detected in kidney tissue); (3) rhabdomyolysis (from fever, myalgia); (4) haemolysis; (5) immune complex GN (rare). Most cases are mild and reversible with fluid resuscitation and supportive care. Aggressive fluid management must be balanced against the risk of fluid overload during the recovery phase when leaked plasma returns to the intravascular space.

Reference: WHO 2009 – Dengue Guidelines; Mallhi et al 2015 – Dengue AKI