Serum creatinine and urea lack diagnostic accuracy for predicting malaria co-infection in HIV-positive children

Abstract

Children under the age of five years in malaria-endemic regions of sub-Saharan Africa face a dual threat from Plasmodium falciparum malaria and HIV-1 infection. Both infections independently cause renal dysfunction, yet the diagnostic value of renal biomarkers in differentiating co-infected from mono-infected children remains uncertain. The objective of this study is to determine whether renal functional markers can predict malaria co-infection among HIV-positive children aged less than five years in Western Kenya. A cross-sectional case–control study involving 138 HIV-positive children (69 malaria-positive, 69 malaria-negative) attending Kakamega County Teaching and Referral Hospital was conducted. Malaria was confirmed by microscopy and rapid diagnostic tests. Serum creatinine and urea were quantified using an automated clinical chemistry analyzer. Parasitemia levels, age, and gender were compared between groups using the Mann-Whitney U and chi-square tests. Diagnostic performance of the renal functional markers was evaluated using ROC curve analysis. Children co-infected with malaria and HIV were younger (median 14.4 months in the co-infected vs. 24.0 months in the mono-infected group, p = 0.039). A higher proportion of co-infected children were female (64.2%) compared to the mono-infected group (35.8%, p=0.014). The median parasite density among co-infected children was 1,870 parasites/µL (range 1,806–80,025). Serum creatinine (93.0 µmol/L vs. 80.0 µmol/L, p = 0.001) and urea (4.9 mmol/L vs. 3.7 mmol/L, p < 0.0001) were significantly higher in the co-infected than mono-infected children. However, ROC analysis revealed poor discriminative ability (AUC < 0.70) for both markers. Despite elevated renal markers among co-infected children, creatinine and urea lack sufficient diagnostic accuracy to predict malaria co-infection in HIV-positive pediatric populations. Integrating parasitological testing with routine renal monitoring remains essential for accurate case management in co-endemic regions.