Flore Makaya Talu 1, Therance Tobo Matoka 1, Agathe Bikupe Nkoy 1,* , Bienvenu Matondo Odio 1, Orielle Mafuta Minimbu 1, Floreen Maluwenze Mumaka 1, Yoli Ngamukuba Ndiyo 1, Dieumerci Kabasele Betukumesu 1, Orly Kazadi wa Kazadi 1, Célestin Ndosimau Nsibu 2 and Pépé Mfutu Ekulu 1
Abstract
Malaria remains a leading cause of morbidity and mortality among children in sub-Saharan Africa. Acute kidney injury (AKI) is increasingly recognized as a frequent and severe
complication of pediatric severe malaria, yet it remains largely underdiagnosed. This
under-recognition is driven by important limitations in current diagnostic approaches. The
World Health Organization (WHO) criteria rely on fixed serum creatinine (SCr) thresholds
that are poorly adapted to children, whereas Kidney Disease Improving Global Outcomes
(KDIGO) criteria require baseline SCr (bSCr) values that are rarely available in low-resource
settings. The estimation of bSCr using back-calculation methods is further complicated
by population-specific factors, particularly malnutrition, which reduces creatinine generation
and may mask kidney injury. In addition, urine output (UO) monitoring is often
underutilized despite its diagnostic value, and access to laboratory testing remains limited.
Emerging biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL),
cystatin C, and kidney injury molecule-1 (KIM-1) show promise for early detection and risk
stratification but remain insufficiently validated in African pediatric populations. In this
narrative review, we highlight key challenges in diagnosing malaria-associated AKI (MAKI)
in children and discuss potential strategies to improve early detection in resource-limited
settings, with the aim of reducing morbidity and mortality.
Keywords: severe malaria; acute kidney injury; children; creatinine; biomarkers;
sub-Saharan Africa
https://doi.org/10.3390/kidneydial6020033
Kidney Dial. 2026, 6, 33