Severe acute renal failure in malaria

• Published in: Journal of postgraduate medicine (Bombay) Vol. 47; no. 1; pp. 24 - 26
• Main Authors: Mehta, K S, Halankar, A R, Makwana, P D, Torane, P P, Satija, P S, Shah, V B
• Format: Journal Article
• Language: English
• Published: India 01-01-2001
• Subjects: Acute Kidney Injury - diagnosis; Acute Kidney Injury - parasitology; Adult; Aged; Aged, 80 and over; Animals; Antimalarials - therapeutic use; Drug Resistance, Multiple; Humans; Incidence; India - epidemiology; Malaria - complications; Malaria - diagnosis; Malaria - drug therapy; Malaria - epidemiology; Malaria, Falciparum - complications; Malaria, Falciparum - diagnosis; Malaria, Vivax - complications; Malaria, Vivax - diagnosis; Middle Aged; Plasmodium falciparum - isolation & purification; Plasmodium vivax - isolation & purification; Quinine - therapeutic use; Retrospective Studies; India
• ISSN: 0022-3859

We have noticed a recent rise in the incidence and severity of acute renal failure (ARF) in malaria.
To study the incidence, severity and outcome of ARF in malaria.
It is a retrospective analysis of data of one year from a tertiary medical centre in a metropolitan city.
Patients with ARF and smear positive malaria were evaluated.
Results were expressed as mean, range and standard deviation.
Out of 402 detected smear positive malaria, 24 had ARF. Eighteen were of the age group 21-40 years. Plasmodium falciparum (PF) was detected in 16, Plasmodium vivax in three, and mixed infection in five. Non-oliguric ARF was seen in 14. Eighteen showed severe ARF (Serum creatinine >5 mg%). Twenty-two patients needed dialysis. Prolonged ARF lasting for 2-6 weeks was seen in eight. Seventeen patients recovered completely, while seven showed fatal combination of disseminated intravascular coagulation (DIC), acute respiratory distress syndrome (ARDS), severe ARF and PF malaria. No response was seen to chloroquine and artesunate given alone and twenty patients required quinine.
ARF necessitating dialysis was seen in 92% of patients with ARF in malaria. PF infection, severe ARF, DIC and ARDS were poor prognostic factors. Resistance was noted to both chloroquine and artesunate.