Rodney Ogwang, MSc
Nominated From: Indiana University
Research Site: Global Health Uganda
Research Area: Infection associated kidney injury
Primary Mentors: Dr. Andrea Conroy and Dr. Robert Opoka
Evaluating the etiology and pathophysiology of malaria and non-malarial acute kidney injury
The goal of this study is to improve our understanding of severe malaria associated acute kidney injury. Acute kidney injury (AKI) is an abrupt loss of kidney function that occurs in 25-59% of African children hospitalized with severe Plasmodium falciparum malaria. AKI is one of the strongest risk factors for death in children with severe malaria (SM) and is associated with increased long-term risk of developing chronic kidney disease. The mechanisms of SM-associated AKI (SM-AKI) remain unclear. During SM, parasites invade and replicate within red blood cells. The red blood cells can stick to blood vessels blocking blood flow resulting in inadequate oxygen delivery and blood cells rupture as part of the parasite lifecycle and release hemolysis-associated toxins that can damage the kidney and cause blackwater fever (;coca-cola’ colored urine). Therefore, unique features associated with the malaria life cycle may lead to differences in the etiology of AKI in severe malaria compared to AKI from other causes.
The purpose of the proposed study is to define the etiology of SM-AKI compared to other causes of AKI. I will address this using an existing cohort of children hospitalized with and without malaria enrolled in a multi-site prospective cohort study evaluating solar-powered oxygen delivery systems to reduce mortality in hospitalized children. I will test a panel of biomarkers for immune and endothelial activation, and kidney injury using a biorepository of serum and urine samples archived at the CHILD lab in Kampala Uganda. Also, I will investigate the incidence and etiology of blackwater fever.
AKI has been identified as a risk factor for hospital readmission, post-discharge mortality, chronic kidney disease, and long-term neurocognitive and behavioural problems in children surviving malaria. There are limited data on the etiology of AKI in sub-Saharan Africa compared to other settings, as sites within sub-Saharan Africa have been historically excluded from pediatric AKI research. As AKI occurs in an estimated 24-59% of hospitalized children with malaria, improved understanding of AKI etiology and pathogenesis is a priority to ensure children have the opportunity to survive and thrive.
- Andrea Conroy, PhD
- Robert Opoka, MD
- Richard Idro, MBChB, MMED, PhD
- Dr. Micheal Hawkes