Renal involvement in Gambian children with cerebral or mild malaria

Kidney function was studied in 80 Gambian children with cerebral malaria, 7 3 children with mild malaria, and in 19 children with other febrile illness es. Serum creatinine was measured. and the excretion in urine of immunoglob ulin G, transferrin, albumin and alpha 1 microglobulin was determined. Twen ty-five percent of children with cerebral malaria, and 4% of children with mild malaria had an elevated serum creatinine above 62 mu mol/l. Increased urinary protein excretion was frequent: 53% of children with cerebral malar ia had a glomerulo-tubular pattern of protein excretion, and 46% a tubular pattern. Median albuminuria was 68 mg/l in children with cerebral malaria, 18 mg/l in children with mild malaria, and 9 mg/l in febrile children with other diseases (P < 0.0001). There was no significant association between t he proteinuria and height of fever or the degree of parasitaemia and there was no significant association between death and sings of renal impairment. Renal involvement is common in children with malaria in The Gambia, with p rerenal glomerular, and tubulo-interstitial factors contributing. It is mor e pronounced in children with cerebral malaria than in those with mild mala ria. However, renal dysfunction is relatively mild and does not indicate a worse prognosis.