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Falciparum Parasitaemia AKI Severity — ESENeph MCQ

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ModerateAcute Kidney InjuryFalciparum Parasitaemia AKI SeverityESENeph

A 41-year-old man is admitted with AKI. He has recently returned from Thailand with fever and jaundice. Blood film shows Plasmodium falciparum parasitaemia of 8%. Creatinine is 420 umol/L (baseline unknown), K+ 5.8 mmol/L, urine output 300 mL over 12 hours. What is the MOST important factor determining AKI severity in falciparum malaria?

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Correct answer: A — Degree of parasitaemia

In Plasmodium falciparum malaria, the degree of parasitaemia is the most important determinant of AKI severity. Parasitaemia >5% is classified as severe malaria. The mechanisms of AKI include cytoadherence of parasitised red cells to renal endothelium causing microvascular obstruction, haemolysis-induced tubular injury, immune complex deposition, and volume depletion. The parasitaemia level correlates with the degree of microvascular sequestration and end-organ damage. This patient has severe malaria (8% parasitaemia) with AKI requiring urgent artesunate IV and consideration for renal replacement therapy if hyperkalaemia or fluid overload progresses.

Reference: WHO 2022 – Severe Malaria Treatment Guidelines; Barsoum 2000 – Malarial AKI