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Acute Kidney Injury in East Africa in an Era of Converging Renal Stressors: A Multiple‐Hit Narrative Review

Year: 2026

Type: review

Abstract: Background: Acute kidney injury (AKI) remains an important cause of morbidity and mortality in East Africa, where infectious disease, volume depletion, hemodynamic instability, and nephrotoxic exposure frequently occur in resource-constrained clinical settings. This review aimed to synthesize regional evidence through a multiple-hit framework focused on three modifiable renal stressor domains. Methods: A structured narrative review of PubMed, Embase, and Scopus was conducted for peer-reviewed human studies published from January 2012 to 18 August 2026 across the 18 Eastern African countries defined by the United Nations M49 framework. Eligible studies examined AKI in relation to volume depletion or hemodynamic compromise, infection or inflammatory illness, and/or nephrotoxic exposure. Results: Of 902 records identified, 420 duplicates were removed, 482 records were screened, 66 full-text reports were assessed, and 45 studies were included. Evidence originated from only six countries: Ethiopia, Uganda, Tanzania, Kenya, Somalia/Somaliland, and Rwanda. Across adult, pediatric, neonatal, obstetric, infectious-disease, emergency, cardiac, and critical-care populations, AKI was associated with dehydration, hemorrhage, hypotension, shock, malaria, sepsis and other infections, nephrotoxic medications, iodinated contrast, and traditional or herbal medicines. The most consistently documented pattern was cohort-level clustering of more than one renal stressor domain within the same clinical populations. Individual-level coexistence was documented in selected studies, whereas detailed temporal sequencing was uncommon. Most studies assessed exposures separately and rarely examined cumulative effects, exposure timing, or statistical interaction. Conclusion: The currently available evidence from East Africa supports a multiple-hit perspective as a clinical organizing framework rather than a proven biological or prognostic model. Because the evidence is geographically concentrated, particularly in Ethiopia, Uganda, and Tanzania, these findings should not be interpreted as representative of all East African settings. Recurrent cohort-level clustering of infectious or inflammatory, hemodynamic, and nephrotoxic stressors was well documented, but patient-level coexistence and temporal sequence remain incompletely characterized. Prospective multicountry studies with patient-level temporal data are needed to determine whether the timing, overlap, duration, or combination of these stressors influences AKI severity, recovery, and longer-term outcomes.

Source: International Journal of Nephrology

DOI: 10.1155/ijne/4263572