Renal protection in severe malaria

Q: Which of the following antipyretic is found to be renal protective in severe malaria? (select one)

A) Acetaminophen 

B) Prednisone

C) Ibuprofen 

Answer: A

Interestingly, acetaminophen is not only the choice to control fever in severe malaria, it also provides protection against renal dysfunction. High fever is common in severe malaria corresponding with endogenous pyrogens release at the time of schizont rupture. Very high fever in such settings may also lead to seizures.

Kidney insufficiency is common in severe malaria due to high extracellular hemoglobin in the setting of intravascular hemolysis which leads to oxidative renal tubular damage. This gets further complicated by fever, dehydration and schizont rupture.

Oral acetaminophen, 1 gram every 6 hours for 72 hour till malaria can be controlled found to provide independent renal protection in severe malaria.

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References:

1. Conroy AL, Hawkes MT, Leligdowicz A, et al. Blackwater fever and acute kidney injury in children hospitalized with an acute febrile illness: pathophysiology and prognostic significance. BMC Med 2022; 20:221.

2. Plewes K, Kingston HWF, Ghose A, et al. Acetaminophen as a Renoprotective Adjunctive Treatment in Patients With Severe and Moderately Severe Falciparum Malaria: A Randomized, Controlled, Open-Label Trial. Clin Infect Dis 2018; 67:991.