Thread by @JanaSharara

1/ 🧵Hello #medtwitter Ready for some NephMadness? 🤯
Not just any madness, but beware your mosquito bites 🦟, because today’s topic is #Malaria and kidney involvement.

#NephTwitter #NephMadness
@NephMadness

2/ 🧵 Where does the word malaria originate from?

PMID: 11053494

3/🧵 Malaria is an Italian word composed of “mala” and “aria,” meaning bad (malus) air (aeris). It was first used to describe a fever (miasma) mistakenly attributed to exposure to poisonous air.
PMID: 11053494, 9641206

4/🧵The disease’s relation to mosquito was suggested in 5th century by Indian physician Susruta & it was only in 1880 that Charles Laveran, French physician, discovered the true causative agent as a sporozoan of genus Plasmodium. Today, malaria makes a comeback!
PMID: 9641206

5/🧵 Malaria is endemic to the tropics. The major species to torment humans are P. falciparum (the most common and dangerous), P. vivax, P. ovale and P. malariae.
Up to 95% of malaria cases occur in Africa.

VA by @krishnadoctor1

6/ 🧵 One famous Med Trivia and Boards question, what is the name of the mosquito that transmits malaria?

PMID: 27367318

7/ 🧵 Malaria, the most common parasitic disease in the world, is transmitted by the Anopheles mosquito. The transmission of malaria requires the interaction between the host , the vector and the parasite, as shown in the life cycle below. VA by @NephroMythri
PMID: 27367318

8/ 🧵What are the most common symptoms of malaria?

9/ 🧵 Malaria signs and symptoms typically begin within a few weeks after being bitten by an infected mosquito:
🤒Fever
🥶Chills
🫀Tachcardia
🫁Tachypnea
😰Fatigue
💪🏼Myalgias
💆🏻‍♀️Headache
🙇🏻‍♀️Anorexia
🤢GI disturbance
🦴arthralgias.
PMID: 7717795

10/ 🧵 Severe malaria is defined as P. falciparum infection with one of the below criteria.
PMID: 25214480
(Table from UpToDate)

11 🧵 How common is Renal impairment in malaria?

12/ 🧵 Kidney involvement, reported in 20 to 50% of malaria cases, manifests as
🔻proteinuria
🔻microalbuminuria
🔻urinary casts,
It’s kidney involvement is most seen in P. falciparum infections, contributing to high mortality rate, around 75% of cases.
PMID: 28793022

13/🧵 Kidney disease in severe malaria is primarily due to erythrocyte abnormalities.
Disease manifests in 🔘glomeruli, 〰️tubules and in the ♾interstitial region.

14/🔴Parasitized red cells tend to adhere to healthy erythrocytes, blood platelets and capillary endothelium =>forming rosettes and clumps=> cytokine release & impaired microcirculation => kidney injury (ATN) and hemodynamic instability (hypovolemia and shock).
PMID: 11053494

15/ 🧵 Immune system activation in malaria can go through Th1 and Th2:
1️⃣ Th1 prevails => acute interstitial nephritis and acute glomerulonephritis.
2️⃣Th2 prevails => complement activation => deposits of immune complexes => glomerulonephritis.
PMID: 11053494, 28793022

16/🧵 Hepatic dysfunction also contributes to renal injury.
🌝Jaundice and hepatomegaly: direct and indirect hyperbilirubinemia, can lead to cast nephropathy and AKI
Liver disease and its complications can also cause AKI via hepato-renal syndrome.
PMID: 11053494, 28793022

17/🧵In summary, a multitude of factors contribute to the occurrence of renal complications. These include hypovolemia, vasoconstriction, hemolysis, erythrocyte parasitemia, immune complexes deposition in glomeruli, microcirculation dysfunction and rhabdomyolysis.
PMID: 11053494

18/🧵Treatment of malaria-associated renal failure includes
🌟antimalarial drugs
🌟correction of hydroelectrolytic disturbances
🌟fluid replacement
🌟dialysis
PMID: 22279340, 28793022

19/🧵 Until next time, wear your mosquito repellants and consult your doctor before visiting an endemic country. Stay hydrated and protect your kidneys! Special thanks to @NSMCinternship @NephMadness