Malaria-Associated Acute Kidney Injury: A Key Driver of Mortality in Endemic Regions

Background: Malaria remains a major global health challenge, particularly in endemic regions where severe disease contributes substantially to morbidity and mortality. Among its systemic complications, malaria-associated acute kidney injury (MAKI) is increasingly recognized as a significant yet underappreciated contributor to poor clinical outcomes. Despite advances in antimalarial therapy, MAKI continues to be associated with high mortality and growing evidence suggests a link to long-term renal sequelae, including chronic kidney disease (CKD). This review synthesizes current evidence on the epidemiology, pathophysiology, clinical presentation, diagnosis, management, and long-term outcomes of MAKI. Methods: A focused PubMed/MEDLINE search (2015-2025) was conducted to identify relevant studies across different age groups and Plasmodium species. Emphasis was placed on epidemiology, mechanisms of kidney injury, clinical features, management strategies, and renal outcomes. Studies were selected based on relevance to the review objectives. Results: MAKI is a serious complication of severe malaria, resulting from a multifactorial process involving intravascular hemolysis, microvascular obstruction, inflammation, endothelial dysfunction, and volume depletion. Plasmodium falciparum remains the most commonly implicated species, although Plasmodium vivax and Plasmodium knowlesi are increasingly recognized causes. Clinically, MAKI is associated with prolonged hospitalization, increased need for renal replacement therapy, and higher mortality. Emerging evidence also indicates that survivors are at risk of incomplete renal recovery and progression to CKD. Conclusion: MAKI is a critical driver of both acute mortality and long-term kidney disease in malaria. Early recognition, prompt management, and post-recovery renal monitoring are essential to improve outcomes. Greater awareness and further research are needed to define preventive strategies and long-term renal implications, particularly in resource-limited endemic regions.