# Malaria‐Associated Acute Kidney Injury in a Low‐Endemic Region: A Case Series of Five Imported Plasmodium falciparum Infections

## TL;DR

This case series reports five imported cases of Plasmodium falciparum malaria complicated by acute kidney injury in Tanzania, emphasizing the challenges and outcomes of managing this severe condition.

## Contribution

The study highlights MAKI's underrecognized burden in a low-endemic, resource-limited region within an endemic country.

## Key findings

- All five patients presented with severe kidney injury and required hemodialysis for four of them.
- Despite the severity, overall survival was 100% with timely management.
- The study underscores the modified natural history and diagnostic challenges of MAKI in low-endemic regions.

## Abstract

Malaria‐associated acute kidney injury (MAKI) is a formidable and potentially fatal complication of malaria. Early recognition and timely management can significantly reduce morbidity and mortality, particularly in resource‐limited settings. This case series describes five patients with imported Plasmodium falciparum complicated by MAKI who were treated at Kilimanjaro Christian Medical Center (KCMC) in northeastern Tanzania between December 2023 and January 2024. The cohort comprised of four males and one female, with a mean age of 38.2 ± 18.6 years. All patients presented with a history of fever and a recent history of travel to high‐endemic regions. The mean serum creatinine and urea levels at admission were 736 ± 346.4 μmol/L and 23.1 ± 14.1 mmol/L, respectively. Four patients required hemodialysis, and one experienced malaria recrudescence. Overall survival was 100%. This case series highlights pathophysiological mechanisms, clinical presentations, diagnostic challenges, and management outcomes of MAKI, illustrating its modified natural history. Despite advances in understanding MAKI, early diagnostic and treatment challenges persist. This case series aimed to elucidate the underrecognized burden and patterns of MAKI in a resource‐limited, low‐endemic region within an endemic country.