From the Guidelines
Malaria can cause hematuria through several mechanisms, and treatment should focus on addressing the underlying malarial infection with appropriate antimalarial medications, such as intravenous artesunate for severe cases, as recommended by the most recent guidelines 1.
Key Considerations
- Severe falciparum malaria can lead to blackwater fever, characterized by massive intravascular hemolysis resulting in hemoglobinuria and hematuria.
- For uncomplicated falciparum malaria, artemisinin-based combination therapies (ACTs) like artemether-lumefantrine are first-line treatments.
- Supportive care including hydration is essential to protect kidney function.
- Patients should be monitored for worsening hematuria, decreasing hemoglobin levels, and signs of acute kidney injury.
Mechanisms of Hematuria in Malaria
- Direct red blood cell destruction by the parasite
- Immune-mediated hemolysis
- Disseminated intravascular coagulation or acute kidney injury in severe cases
Monitoring and Treatment
- Monitoring of parasitaemia should be done every 12 hours after starting treatment until a decline to <1% is observed, as recommended by recent guidelines 1.
- Patients with suspected urinary tract infection as a cause of microhematuria should have urine cultures performed, preferably before antibiotic therapy, to confirm an infection 1.
- Intravenous artesunate is the recommended treatment for severe malaria, with a dose of 2.4 mg/kg at 0,12,24 hours, then daily, until oral therapy can be tolerated 1.
Important Considerations for Hematuria
- Gross hematuria has a high association with malignancy, and all patients with gross hematuria should have a full urologic workup 1.
- Patients with microhematuria have a low risk of malignancy, but should still be evaluated for underlying causes, including urinary tract infection, glomerulonephritis, and other conditions 1.
From the Research
Malaria and Hematuria
- There is no direct evidence in the provided studies that links malaria to hematuria.
- Malaria is a disease caused by protozoan parasites of the genus Plasmodium, and its treatment and prevention are well-documented in the studies 2, 3, 4, 5, 6.
- The studies focus on the efficacy and safety of artemisinin-based combination therapies (ACTs) for the treatment of uncomplicated malaria, as well as the prevention and diagnosis of the disease.
- None of the studies mention hematuria as a symptom or complication of malaria, or as a side effect of ACTs.
- Therefore, there is no research evidence available to assist in answering the question about the relationship between malaria and hematuria.