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Scientists link behavioral problems to malaria-related kidney injury

IU School of Medicine • 12/17/19

Earlier this year, researchers determined that a common complication for children recovering from severe malaria is linked to long-term cognitive impairment. Now, they’ve worked to define how those impairments translate to behavioral outcomes for the thousands of children affected—especially in sub-Saharan Africa, where they are at high risk for parasite exposure.

In a study published in PLOS One, Indiana University School of Medicine scientists Andrea Conroy, PhD, Chandy John, MD, and their partners at Makerere University of School of Medicine in Kampala, Uganda, performed behavioral analyses on hundreds of Ugandan children between the ages of 1.5 to 12 years old who were recovering from severe malaria.

Their goal was to determine whether there were differences in behavior, or behavioral outcomes, between children with and without AKI.

The study is the first to identify a relationship between AKI and long-term behavioral outcomes in children surviving a critical illness complicated by kidney injury. They found that children over 6 years old who experienced malaria-related AKI had an increased risk for exhibiting problematic behavior—including aggression, rule-breaking, impulsivity, and poor emotional control—for up to two years after hospital discharge.

“This study provides insight into clinical complications that may impact long-term development in children following severe malaria,” said Conroy, who is a global leader in understanding AKI in children with severe malaria. “In order to reduce the long-term consequences of severe malaria and children’s neurodevelopment, behavior and quality of life, we need effective interventions to promote recovery.”

The study suggests that hospital interventions—such as routine screening for kidney injury and improved clinical management of AKI in low-resource settings—can improve patient care and long-term outcomes in kids over 6 who are recovering from severe malaria. Conroy said that there is an urgent need to improve support for families with children at higher risk of long-term cognitive and behavioral problems.

AKI has been found to affect one-third of the children admitted with severe malaria, but it’s also a common complication in children who experience other critical illnesses in both high-, low-, and middle-income countries. Further studies are necessary to determine whether AKI has a similar link to long-term adverse outcomes in other young children who experience illness-related kidney injury.

The group will continue to investigate the mechanisms of AKI and the factors that contribute to its development.

The above referenced study is titled “Acute kidney injury in Ugandan children with severe malaria is associated with long-term behavioral problems” and was published in PLOS One on Tuesday, December 17, 2019. In addition to Indiana University School of Medicine, authors who contributed to this work represent the Children’s Hospital of Philadelphia, Makerere University of School of Medicine, and the University of Oxford.

 Andrea Conroy, PhD, is an assistant professor of pediatrics in the Department of Pediatrics Division Infectious Disease. She conducts her research within the Ryan White Center for Pediatric Infectious Diseases and Global Health.

 Chandy John, MD, is the Ryan White Professor of Pediatrics and chief of the Department of Pediatrics Division of Infectious Disease. He is the director of the Ryan White Center for Pediatric Infectious Disease and Global Health.