Renal Localization of Plasmodium vivax and Zoonotic Monkey Parasite Plasmodium knowlesi in Malaria Associated Acute Kidney Injury

Acute kidney injury (AKI) is a frequent presentation in Plasmodium vivax (P. vivax) associated severe malaria. However, tissue presence of P. vivax parasites in the kidney has never been demonstrated. In the present study, we show that renal biopsies from malaria associated AKI patients harbor the human malaria parasite P. vivax and, in several cases, the zoonotic monkey malaria parasite P. knowlesi in addition to P. vivax. Presence of microvascular injury in a majority of the malaria associated AKI cases suggests vascular involvement of P. vivax and P. knowlesi. This study implicates Plasmodium species as a possible pathogenic mechanism for AKI, and suggests host renal tissue interaction of P. vivax and P. knowlesi.