From the Research
Hematuria in malaria should be treated with artemisinin-based combination therapies (ACTs) such as artemether-lumefantrine or dihydroartemisinin-piperaquine, and in severe cases, intravenous artesunate is recommended. The treatment of malaria hematuria focuses on addressing the underlying malaria infection. According to the most recent and highest quality study available 1, artesunate-mefloquine is an effective and safe treatment option for children younger than 5 years with uncomplicated Plasmodium falciparum malaria in Africa. However, for the treatment of hematuria in malaria, the focus should be on using ACTs that are effective against the specific Plasmodium species causing the infection.
Treatment Options
- Artemether-lumefantrine (typical adult dose: 4 tablets twice daily for 3 days)
- Dihydroartemisinin-piperaquine
- For severe malaria with hematuria, intravenous artesunate (2.4 mg/kg at 0,12,24, and 48 hours) is recommended, followed by a complete oral ACT course once the patient can tolerate oral medication.
Supportive Care
- Maintaining hydration with intravenous fluids if needed
- Monitoring kidney function through blood tests (creatinine, BUN)
- Ensuring adequate urine output
- Patients should be monitored for complications like acute kidney injury, which may occur in severe malaria.
The mechanism behind malarial hematuria involves both direct damage from parasitized red blood cells obstructing kidney vessels and immune-mediated glomerular injury, which can lead to microscopic or macroscopic blood in the urine. The World Health Organization recommends treating uncomplicated cases of malaria with artemisinin combination therapy, except in the first trimester of pregnancy 2. Severe malaria is mainly caused by Plasmodium falciparum, and children, pregnant patients, and people who are not from endemic regions are at highest risk of severe malaria.