Acute interstitial nephritis with podocyte foot-process effacement complicating Plasmodium falciparum infection

BackgroundMalarial acute renal failure (MARF) is a component of the severe malaria syndrome, and complicates 1-5% of malaria infections. This form of renal failure has not been well characterized by histopathology.Case presentationA 44year-old male presented to the emergency department with a 5-day history of fever and malaise after returning from Nigeria. A blood film was positive for Plasmodium falciparum. His creatinine was 616 mu mol/L coming from a normal baseline of 89 mu mol/L. He had a urine protein:creatinine ratio of 346mg/mmol (4.4g/L). He required dialysis. A renal biopsy showed acute interstitial nephritis with podocyte foot-process effacement. He was treated with artesunate and his renal function improved. At 1year follow-up his creatinine had plateaued at 120 mu mol/L with persistent low-grade proteinuria.ConclusionAcute interstitial nephritis and podocyte foot-process effacement might be under-recognized lesions in MARF. Studying the mechanisms of MARF could give insight into the immunopathology of severe malaria.