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Zhang J, Huang Z, Lin Q, Hu W, Zhong H, Zhang F, Huang J. The correlation between serum angiopoietin-2 levels and acute kidney injury (AKI): a meta-analysis. Clin Chem Lab Med 2024; 0:cclm-2024-0365. [PMID: 38915251 DOI: 10.1515/cclm-2024-0365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/10/2024] [Indexed: 06/26/2024]
Abstract
INTRODUCTION The correlation between serum angiopoietin-2 levels and acute kidney injury (AKI) is a topic of significant clinical interest. This meta-analysis aims to provide a comprehensive evaluation of this relationship. CONTENT A systematic search was conducted in PubMed, Embase, Web of Science, and Cochrane databases up to October 11, 2023. The included studies were evaluated using the Newcastle-Ottawa Scale (NOS) and Methodological Index for Non-Randomized Studies (MINORS). Weighted mean differences (WMD) and odds ratios (OR) were calculated using random-effects models. Sensitivity analysis, funnel plots, and Egger's test were used to assess the robustness and publication bias of the findings. Subgroup analyses were performed to explore potential variations between adults and children. SUMMARY Eighteen studies encompassing a total of 7,453 participants were included. The analysis revealed a significant elevation in serum angiopoietin-2 levels in patients with AKI compared to those without (WMD: 4.85; 95 % CI: 0.75 to 0.27; I²=93.2 %, p<0.001). Subgroup analysis indicated significantly higher angiopoietin-2 levels in adults with AKI (WMD: 5.17; 95 % CI: 3.51 to 6.83; I²=82.6 %, p<0.001), but not in children. Additionally, high serum angiopoietin-2 levels were associated with an increased risk of AKI (OR: 1.58; 95 % CI: 1.39 to 1.8; I²=89.1 %, p<0.001). Sensitivity analysis validated the robustness of these results, showing no substantial change in the overall effect size upon the exclusion of individual studies. OUTLOOK This meta-analysis supports a significant association between elevated serum angiopoietin-2 levels and increased risk of AKI. The observed differential association between adults and children highlights the need for further targeted research to understand these age-specific variations.
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Affiliation(s)
- Juncheng Zhang
- The School of Clinical Medicine, 74551 Fujian Medical University , Fuzhou, Fujian, China
| | - Zhengjie Huang
- The School of Clinical Medicine, 74551 Fujian Medical University , Fuzhou, Fujian, China
| | - Qin Lin
- The School of Clinical Medicine, 74551 Fujian Medical University , Fuzhou, Fujian, China
- Department of Nephrology, Xiamen Key Laboratory of Precision Diagnosis and Treatment of Chronic Kidney Disease, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
- Department of Nephrology, Fujian Clinical Research Center for Chronic Glomerular Disease, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Weiping Hu
- The School of Clinical Medicine, 74551 Fujian Medical University , Fuzhou, Fujian, China
- Department of Nephrology, Xiamen Key Laboratory of Precision Diagnosis and Treatment of Chronic Kidney Disease, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
- Department of Nephrology, Fujian Clinical Research Center for Chronic Glomerular Disease, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Hongbin Zhong
- The School of Clinical Medicine, 74551 Fujian Medical University , Fuzhou, Fujian, China
- Department of Nephrology, Xiamen Key Laboratory of Precision Diagnosis and Treatment of Chronic Kidney Disease, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
- Department of Nephrology, Fujian Clinical Research Center for Chronic Glomerular Disease, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Fengling Zhang
- The School of Clinical Medicine, 74551 Fujian Medical University , Fuzhou, Fujian, China
- Department of Nephrology, Xiamen Key Laboratory of Precision Diagnosis and Treatment of Chronic Kidney Disease, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
- Department of Nephrology, Fujian Clinical Research Center for Chronic Glomerular Disease, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jiyi Huang
- The School of Clinical Medicine, 74551 Fujian Medical University , Fuzhou, Fujian, China
- Department of Nephrology, Xiamen Key Laboratory of Precision Diagnosis and Treatment of Chronic Kidney Disease, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
- Department of Nephrology, Fujian Clinical Research Center for Chronic Glomerular Disease, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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Long B, MacDonald A, Liang SY, Brady WJ, Koyfman A, Gottlieb M, Chavez S. Malaria: A focused review for the emergency medicine clinician. Am J Emerg Med 2024; 77:7-16. [PMID: 38096639 DOI: 10.1016/j.ajem.2023.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/18/2023] [Accepted: 11/23/2023] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Malaria is a potentially fatal parasitic disease transmitted by the Anopheles mosquito. A resurgence in locally acquired infections has been reported in the U.S. OBJECTIVE This narrative review provides a focused overview of malaria for the emergency clinician, including the epidemiology, presentation, diagnosis, and management of the disease. DISCUSSION Malaria is caused by Plasmodium and is transmitted by the Anopheles mosquito. Disease severity can range from mild to severe. Malaria should be considered in any returning traveler from an endemic region, as well as those with unexplained cyclical, paroxysms of symptoms or unexplained fever. Patients most commonly present with fever and rigors but may also experience cough, myalgias, abdominal pain, fatigue, vomiting, and diarrhea. Hepatomegaly, splenomegaly, pallor, and jaundice are findings associated with malaria. Although less common, severe malaria is precipitated by microvascular obstruction with complications of anemia, acidosis, hypoglycemia, multiorgan failure, and cerebral malaria. Peripheral blood smears remain the gold standard for diagnosis, but rapid diagnostic tests are available. Treatment includes specialist consultation and antimalarial drugs tailored depending on chloroquine resistance, geographic region of travel, and patient comorbidities. Supportive care may be required, and patients with severe malaria will require resuscitation. Most patients will require admission for treatment and further monitoring. CONCLUSION Emergency medicine clinicians should be aware of the presentation, diagnosis, evaluation, and management of malaria to ensure optimal outcomes.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - Austin MacDonald
- Department of Emergency Medicine, Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Stephen Y Liang
- Divisions of Emergency Medicine and Infectious Diseases, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, USA.
| | - William J Brady
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, USA
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Summer Chavez
- Department of Health Systems and Population Health Sciences, Tilman J. Fertitta Family College of Medicine, USA.
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Poespoprodjo JR, Douglas NM, Ansong D, Kho S, Anstey NM. Malaria. Lancet 2023; 402:2328-2345. [PMID: 37924827 DOI: 10.1016/s0140-6736(23)01249-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/22/2023] [Accepted: 06/16/2023] [Indexed: 11/06/2023]
Abstract
Malaria is resurging in many African and South American countries, exacerbated by COVID-19-related health service disruption. In 2021, there were an estimated 247 million malaria cases and 619 000 deaths in 84 endemic countries. Plasmodium falciparum strains partly resistant to artemisinins are entrenched in the Greater Mekong region and have emerged in Africa, while Anopheles mosquito vectors continue to evolve physiological and behavioural resistance to insecticides. Elimination of Plasmodium vivax malaria is hindered by impractical and potentially toxic antirelapse regimens. Parasitological diagnosis and treatment with oral or parenteral artemisinin-based therapy is the mainstay of patient management. Timely blood transfusion, renal replacement therapy, and restrictive fluid therapy can improve survival in severe malaria. Rigorous use of intermittent preventive treatment in pregnancy and infancy and seasonal chemoprevention, potentially combined with pre-erythrocytic vaccines endorsed by WHO in 2021 and 2023, can substantially reduce malaria morbidity. Improved surveillance, better access to effective treatment, more labour-efficient vector control, continued drug development, targeted mass drug administration, and sustained political commitment are required to achieve targets for malaria reduction by the end of this decade.
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Affiliation(s)
- Jeanne Rini Poespoprodjo
- Centre for Child Health and Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Indonesia; Mimika District Hospital and District Health Authority, Timika, Indonesia; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Nicholas M Douglas
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Infectious Diseases, Christchurch Hospital, Te Whatu Ora Waitaha, Christchurch, New Zealand; Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Daniel Ansong
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Steven Kho
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Indonesia; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Infectious Diseases, Royal Darwin Hospital, Darwin, NT, Australia
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Vasquez M, Sica M, Namazzi R, Opoka RO, Sherman J, Datta D, Duran-Frigola M, Ssenkusu JM, John CC, Conroy AL, Rodriguez A. Xanthine oxidase levels and immune dysregulation are independently associated with anemia in Plasmodium falciparum malaria. Sci Rep 2023; 13:14720. [PMID: 37679382 PMCID: PMC10484935 DOI: 10.1038/s41598-023-41764-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/31/2023] [Indexed: 09/09/2023] Open
Abstract
Severe anemia is an important contributor to mortality in children with severe malaria. Anemia in malaria is a multi-factorial complication, since dyserythropoiesis, hemolysis and phagocytic clearance of uninfected red blood cells (RBCs) can contribute to this syndrome. High levels of oxidative stress and immune dysregulation have been proposed to contribute to severe malarial anemia, facilitating the clearance of uninfected RBCs. In a cohort of 552 Ugandan children with severe malaria, we measured the levels of xanthine oxidase (XO), an oxidative enzyme that is elevated in the plasma of malaria patients. The levels of XO in children with severe anemia were significantly higher compared to children with severe malaria not suffering from severe anemia. Levels of XO were inversely associated with RBC hemoglobin (ρ = - 0.25, p < 0.0001), indicating a relation between this enzyme and severe anemia. When compared with the levels of immune complexes and of autoimmune antibodies to phosphatidylserine, factors previously associated with severe anemia in malaria patients, we observed that XO is not associated with them, suggesting that XO is associated with severe anemia through an independent mechanism. XO was associated with prostration, acidosis, jaundice, respiratory distress, and kidney injury, which may reflect a broader relation of this enzyme with severe malaria pathology. Since inhibitors of XO are inexpensive and well-tolerated drugs already approved for use in humans, the validation of XO as a contributor to severe malarial anemia and other malaria complications may open new possibilities for much needed adjunctive therapy in malaria.
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Affiliation(s)
- Marilyn Vasquez
- New York University School of Medicine, 430E 29th St, New York, NY, 10016, USA
| | - Margaux Sica
- New York University School of Medicine, 430E 29th St, New York, NY, 10016, USA
| | - Ruth Namazzi
- Department of Paediatrics, Makerere University College of Health Sciences, Kampala, Uganda
- Global Health Uganda, Kampala, Uganda
| | - Robert O Opoka
- Department of Paediatrics, Makerere University College of Health Sciences, Kampala, Uganda
- Global Health Uganda, Kampala, Uganda
| | - Julian Sherman
- New York University School of Medicine, 430E 29th St, New York, NY, 10016, USA
| | - Dibyadyuti Datta
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Center for Global Health, Indiana University, Indianapolis, IN, 46202, USA
| | | | - John M Ssenkusu
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Chandy C John
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Center for Global Health, Indiana University, Indianapolis, IN, 46202, USA
| | - Andrea L Conroy
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Center for Global Health, Indiana University, Indianapolis, IN, 46202, USA
| | - Ana Rodriguez
- New York University School of Medicine, 430E 29th St, New York, NY, 10016, USA.
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Paasi G, Okalebo CB, Ongodia P, Namayanja C, Eregu EEI, Abongo G, Olupot M, Amorut D, Muhindo R, Okiror W, Ndila C, Olupot-Olupot P. PARIST study protocol: a phase I/II randomised, controlled clinical trial to assess the feasibility, safety and effectiveness of paracetamol in resolving acute kidney injury in children with severe malaria. BMJ Open 2023; 13:e068260. [PMID: 37524553 PMCID: PMC10391814 DOI: 10.1136/bmjopen-2022-068260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) has in the past been considered a rare complication of malaria in children living in high-transmission settings. More recently, however, a growing number of paediatric case series of AKI in severe malaria studies in African children have been published (Artesunate vs Quinine in the Treatment of Severe P. falciparum Malaria in African children and Fluids Expansion as Supportive Therapy trials). The Paracetamol for Acute Renal Injury in Severe Malaria Trial (PARIST) therefore, aims to assess feasibility, safety and determine the effective dose of paracetamol, which attenuates nephrotoxicity of haemoproteins, red-cell free haemoglobin and myoglobin in children with haemoglobinuric severe malaria. METHODS PARIST is a phase I/II unblinded randomised controlled trial of 40 children aged >6 months and <12 years admitted with confirmed haemoglobinuric severe malaria (blackwater fever), a positive blood smear for P. falciparum malaria and either serum creatinine (Cr) increase by ≥0.3 mg/dL within 48 hours or to ≥1.5 times baseline and elevated blood urea nitrogen (BUN) >20 mg/dL. Children will be randomly allocated on a 1:1 basis to paracetamol intervention dose arm (20 mg/kg orally 6-hourly for 48 hours) or to a control arm to receive standard of care for temperature control (ie, tepid sponging for 30 min if fever persists give rescue treatment). Primary outcome is renal recovery at 48 hours as indicated by stoppage of progression and decrease of Cr level below baseline, BUN (<20 mg/dL). Data analysis will be on the intention-to-treat principle and a per-protocol basis.Results from this phase I/II clinical trial will provide preliminary effectiveness data of this highly potential treatment for AKI in paediatric malaria (in particular for haemoglobinuric severe malaria) for a larger phase III trial. ETHICS AND DISSEMINATION Ethical and regulatory approvals have been granted by the Mbale Hospital Institutional Ethics Review Committee (MRRH-REC OUT 002/2019), Uganda National Council of Science and Technology (UNCST-HS965ES) and the National drug Authority (NDA-CTC 0166/2021). We will be disseminating results through journals, conferences and policy briefs to policy makers and primary care providers. TRIAL REGISTRATION NUMBER ISRCTN84974248.
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Affiliation(s)
- George Paasi
- Clinical trials department, Mbale Clinical Research Institute, Mbale, Uganda
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Charles Benard Okalebo
- Clinical trials department, Mbale Clinical Research Institute, Mbale, Uganda
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Paul Ongodia
- Clinical trials department, Mbale Clinical Research Institute, Mbale, Uganda
| | - Cate Namayanja
- Clinical trials department, Mbale Clinical Research Institute, Mbale, Uganda
- Department of Paediatrics and Child Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Egiru Emma Isaiah Eregu
- Department of Paediatrics and Child Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Grace Abongo
- Clinical trials department, Mbale Clinical Research Institute, Mbale, Uganda
| | - Moses Olupot
- Clinical trials department, Mbale Clinical Research Institute, Mbale, Uganda
| | - Denis Amorut
- Clinical trials department, Mbale Clinical Research Institute, Mbale, Uganda
| | - Rita Muhindo
- Clinical trials department, Mbale Clinical Research Institute, Mbale, Uganda
| | - William Okiror
- Clinical trials department, Mbale Clinical Research Institute, Mbale, Uganda
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Carolyne Ndila
- Clinical trials department, Mbale Clinical Research Institute, Mbale, Uganda
| | - Peter Olupot-Olupot
- Clinical trials department, Mbale Clinical Research Institute, Mbale, Uganda
- Faculty of Health Sciences, Department of Community and Public Health, Busitema University, Tororo, Uganda
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Nakuya M, Batte A, Musiime V. Prevalence and factors associated with Acute Kidney Injury among children aged 6month- 12years passing dark urine admitted at Soroti Regional Referral Hospital: A cross-sectional study. RESEARCH SQUARE 2023:rs.3.rs-2871679. [PMID: 37214846 PMCID: PMC10197782 DOI: 10.21203/rs.3.rs-2871679/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Introduction Acute Kidney Injury (AKI) is associated with a high mortality yet survivors are at risk for Hypertension, chronic kidney disease, long term neurocognitive and behavioural problems. Early recognition of patients with possible AKI is crucial for better treatment outcome, hence a need for evidence to guide targeted screening of patients with a risk factor for AKI. We sought to determine the prevalence and factors associated with AKI among children passing dark urine since haemoglobinuria, which presents as dark urine is a known risk factor for AKI. Methodology This was a cross sectional study conducted at Soroti Regional Referral Hospital, among children aged 6month to 12years, who presented with dark urine. Urine colour was assessed using the Hammer Smith colour urine chart, only children with urine colour grade ≥ 5 were recruited. Serum creatinine analysis was done on the day of admission, within 48 hours and at day 7 or discharge. AKI was defined as a ≥ 1.5-fold increase in serum creatininefrom the baseline. Bivariate and multivariate analysis was used to determine factors associates with AKI with p values <0.05 level of significance. Results Between January 2022 - July 2022, we enrolled a total of 255 participantswith median age of 4.0 (IQR, 2.0-6.58) years. About two thirds of the participants were males 157 (61.6%) and majority 111 (43.5%) presented with grade 8 of the urine colour. The prevalence of AKI was 38% (95% CI 32.3% - 44.2%). The factors found to be associated with AKI were grade of the urine colour ≥ 9 (aOR, 3.120 (95% CI 1.34-6.78) and reduced urine output (aOR, 3.226 (95% CI 1.10-9.81). Conclusion The prevalence of AKI among children passing dark urine was high (38%). AKI was more likely to occur if the child was passing urine that is profoundly black and if there is history of reduced urine output. These findings reiterate the need for close monitoring of urine output of hospitalized children particularly those passing dark urine. Screening of those with profoundly black urine or reduced urine output should be done.
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Abstract
Severe malaria is a medical emergency. It is a major cause of preventable childhood death in tropical countries. Severe malaria justifies considerable global investment in malaria control and elimination yet, increasingly, international agencies, funders and policy makers are unfamiliar with it, and so it is overlooked. In sub-Saharan Africa, severe malaria is overdiagnosed in clinical practice. Approximately one third of children diagnosed with severe malaria have another condition, usually sepsis, as the cause of their severe illness. But these children have a high mortality, contributing substantially to the number of deaths attributed to ‘severe malaria’. Simple well-established tests, such as examination of the thin blood smear and the full blood count, improve the specificity of diagnosis and provide prognostic information in severe malaria. They should be performed more widely. Early administration of artesunate and broad-spectrum antibiotics to all children with suspected severe malaria would reduce global malaria mortality.
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Affiliation(s)
- Nicholas J White
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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