Review examines infection-associated acute kidney injury in resource-limited settings

A review in Nature Reviews Nephrology examines infection-associated acute kidney injury (AKI) in resource-limited settings, where enteric, zoonotic and vector-borne infections frequently cause kidney injury outside hospitals. The review describes mechanisms of injury and barriers to prevention, recognition and treatment; the supplied text reports no study sample size or quantitative effect estimates.

Overlapping mechanisms include hypovolaemia, inflammation, endothelial and microcirculatory dysfunction, haemolysis and direct kidney involvement. Reduced kidney reserve from nephron endowment or previous injury can increase susceptibility. Heat exposure and climate-related disruptions can amplify dehydration and infection risk, while antimicrobial resistance and vaccine hesitancy pose additional threats. Limited diagnostic capacity, workforce shortages and poor access to kidney replacement therapy contribute to delayed treatment and adverse outcomes.

The review emphasizes infection prevention, context-appropriate diagnostics, avoidance of iatrogenic kidney injury and affordable, scalable kidney replacement therapies. AKI can progress to acute kidney disease and chronic kidney disease, but the effects of repeated infections and incomplete recovery on long-term kidney health remain poorly characterized. Epidemiological evidence is also skewed towards high-resource settings, limiting understanding of the burden and trajectories in underserved populations.