Today, malaria is a major public health problem in developing countries, particularly in the intertropics [1] .

In 2000, the World Health Organization (WHO) defined severe malaria as the presence of asexual forms of Plasmodium Falciparum in the blood associated with one or more so-called major severity criteria [1] [2] . According to the latest WHO report published on December 4, 2019: Worldwide, the number of malaria cases was estimated at 228 million in 2018, compared with 231 million in 2017. Ninety-three percent of cases were recorded in the African region. Children under 5 accounted for 67% of deaths.

In Mali, malaria remains a major public health problem due to its impact on mortality, morbidity and socio-economic repercussions on the general population [3] .

According to the health information system, malaria constituted 66% of reasons for consultation in 2018 with a case-fatality rate of 1.33‰ [4] . According to the EDSM-VI the prevalence of malaria in children aged 6 - 59 months was 19% in 2018 [5] . In Bamako, at the CHU GT in the pediatrics department, it accounted for 40.4% of consultations, 22.48% of pediatric hospitalizations, and 10.33% of in-hospital deaths [6] . The renal involvement of malaria constitutes a serious form.

The worldwide prevalence of malaria-related renal complications is variously estimated at up to 60% [7] . This prevalence is not homogeneous in Africa, due to studies of different types and carried out in different departments.

The mechanism of this malaria-associated renal complication appears to be acute tubular necrosis associated with hemoglobinuria [8] .

In Gabon, a 2017 study on the frequency of renal involvement during severe childhood malaria at the Service d’Accueil des Urgences Pédiatriques et en réanimation du Centre Hospitalier Universitaire de Libreville revealed a frequency of 0.7% [9] .

In Mali, it represents 23.65% of the causes of admission to the nephrology department of the CHU du Point G [4] .

No study has been carried out on the renal damage caused by severe malaria in our department, which is why we initiated this study, the aim of which is to investigate the prevalence of renal complications of severe malaria in children aged between 1 month and 15 years in the paediatrics department of the Gabriel Touré University Hospital in Bamako.

Our study was carried out in the pediatrics department of the Gabriel TOURE University Hospital in Bamako. Located in the center of the city, the pediatrics department receives patients from all the communes of Bamako and those referred by other localities in Mali. It comprises a neonatology service, a general paediatrics service and a paediatric emergency service. We conducted a retrospective study of the records of children aged 0 to 15 years admitted to the pediatrics department between January 1^st, 2017 and December 31^st, 2019, i.e., (36 months), for severe malaria with a biologically confirmed renal complication.

Data were collected on a survey form after verbal consent from the parent and/or guardian. The variables studied were epidemiological: age, sex, time to consultation, clinical: reason for consultation, signs of examination, paraclinical: RDT, thick drop (GE), Uremia, creatinemia, ABO grouping, RH, haemogram, treatment and evolution. The data collected were entered and analyzed using SPSS version 22 software.

The Chi-square test was used to compare categorical variables. The value of p < 0.05 was considered statistically significant. Data confidentiality has been respected.

The incidence of renal complications of malaria in children was 0.9% (46/4956). Prevalences as low as ours have been found in other series, ranging from 0.56% to 0.7%, reported respectively by Essola L et al. in Gabon [9] and Lalya F et al. in Benin [10] . Higher rates were reported by N. Yannick et al. [11] in Burkina Faso (1.79%) and Kunuanunua et al. [12] in the Democratic Republic of Congo (11.4%). In our study, the sex ratio was 3.6. This value is higher than that of Yannick N et al. [11] in Burkina Faso and Lalya F et al. [10] in Benin, who found a sex ratio of 1.62 and 1.4 respectively. The mean age of patients was 109.2 ± 36 months, with extremes of 08 months and 15 years. This is comparable to that of Essola L et al. [9] in Gabon (102.7 ± 67.7 months). On the other hand, the mean age in our study is lower than that reported by Ibadin et al. [13] in Nigeria (134.4 ± 11.64 months). In our study, malaria was confirmed by thick drop (73.9%) and RDT (56.5%). Our results are superior to those of Yannick N et al. [11] and Keita Y et al. [14] , who found confirmation by GE at 37.7% and 41.8% respectively. On the other handSamaké Z [15] in commune II of Bamako and Diallo Y in commune V of Bamako [16] found 79.35% and 94.3% respectively of positive RDT. Biological anemia was noted in all cases of renal failure. This result is comparable to that found by Yannick N et al. [11] in Burkina Faso in their study. In our study, the mean blood urea level was 79.29 ± 19.19 mmol/l, with extremes of 10 mmol/l and 125 mmol/l. This level is higher than that of Essola L et al. [9] , who found a mean of 40.6 ± 10.4 mmol/l with extremes of 3.4 mmol/l and 72.8 mmol/l. The majority of patients who dialyzed or died had blood urea values well above 60 mmol/l. The mean creatinine level in patients with renal failure in our study was 760.64 μmol/l, with extremes of 19 and 2177 µmol/l. This result is higher than that of Essola L et al. [9] , which was 572.4 μmol/l ± 434.5 μmol/l with extremes of 195 μmol/l and 1461 μmol/l. On the other hand, Yannick N et al. [11] found a mean creatinemia of 1153.7 ± 727.97 μmol/l higher than in our study.

As our department has no hemodialysis unit, parents must be referred to a third referral hospital located some ten kilometers away, and almost all parents had a low socioeconomic level, which is why only 17.4% of patients received hemodialysis. On the other hand, Maiga I et al. [17] Kunuanunua et al. [12] recorded higher hemodialysis rates, with 51% and 23.6% respectively, while Lalya et al. [10] obtained 3.7%. In our study, the majority of patients who underwent dialysis or died had creatinine values well above 265 μmol/l. In our study, paracetamol was the most widely used antipyretic, accounting for 39.1% of cases, and 43.5% of our patients received a blood transfusion. This result is lower than that of Samaké Z [15] , who found that 81.6% of patients benefited from antipyretics. The diuretic chosen was furosemide in 87% of cases. Furosemide administration is most common in poorly equipped environments [2] [10] [19] . Half of our patients (50%) died, and all were aged between 6 and 12 years. Our death rate is higher than those of Nyangui BM [20] in Point G and Keita Y et al. [14] in Senegal, who recorded 16.2% and 12.6% deaths respectively. This high case-fatality rate is thought to be due to delayed diagnosis, the low hemodialysis rate and the low availability of blood products in our mini blood bank to manage cases of anemia.

Renal complications of severe malaria are frequent in our department, with a high mortality rate. Acute renal failure in severe malaria is a rare complication in children. Its occurrence can be life-threatening, especially in the absence of emergency extra-renal purification.