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Background  Acute kidney injury (AKI) is one of the major complications of  Plasmodium falciparum  malaria, especially among non-immune adults. It has recently been revealed that activation of transcription factor nuclear factor kappa B (NF-κB) induces pro-inflammatory gene expression involved in the development of progressive renal inflammatory diseases. The aim of this study was to determine whether urinary sediment NF-κB p65 can act as a biomarker for AKI in patients with  P. falciparum  malaria.    Methods  Urinary sediments from malaria patients, including  Plasmodium vivax  malaria, uncomplicated  P. falciparum  malaria, complicated  P. falciparum  malaria without AKI (serum creatinine-Cr <3 mg/dl) and complicated  P. falciparum  malaria with AKI (Cr ≥3 mg/dl) were used to determine NF-κB p65 level by sandwich enzyme-linked immunosorbent assay (ELISA). Urinary sediments obtained from healthy controls were used as a normal baseline. Correlations between levels of urinary sediment NF-κB p65 and pertinent clinical data were analysed.    Results  Urinary sediment NF-κB p65 levels were significantly increased on the day of admission (day 0) and on day 7 post-treatment in complicated  P. falciparum  malaria patients with AKI, compared with those without AKI ( p  = 0.001,  p  <0.001, respectively),  P. vivax  patients (all  p  <0.001) and healthy controls (all  p  <0.001). NF-κB p65 levels in urinary sediment cells showed a significant positive correlation with serum Cr (Day 0:  r   s   = 0.792;  p  <0.001, Day 7:  r   s   = 0.605;  p  <0.001) and blood urea nitrogen (BUN) (Day 0:  r   s   = 0.839;  p  <0.001, Day 7:  r   s   = 0.596;  p  <0.001).    Conclusions  Urinary sediment NF-κB p65 level is a useful indicator for estimating renal tubular epithelial cell damage and subsequent development of AKI among patients with  P. falciparum  malaria.

Nuclear factor kappa B in urine sediment: a useful indicator to detect acute kidney injury in Plasmodium falciparum malaria