Prakash J, Singh A K, Kumar N S, Saxena R K
Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221005.
J Assoc Physicians India. 2003 Mar;51:265-7.
To analyze incidence, clinical feature and outcome of acute renal failure due to Plasmodium vivax malaria.
MATERIAL & METHOD: This is retrospective analysis of smear positive Plasmodium vivax patients with acute renal failure between Jan 1995 to Dec 2000.
Out of 577 cases of ARF, 93 [falciparum 74 (79.61%); vivax 19 (20.4%)] were related to complicated malaria. 3.2% (19/577) patients, 16 males and three females with age range 17-72, mean 43.3 +/- 13.4 years were due to vivax malaria. Thirteen had only vivax and six had mixed falciparum and vivax infection. The presenting features were fever (100%), jaundice (36.8%), hypotension--eight (42%), encephalopathy--11 (57.9%), sepsis--five (26.3%) and DIC--four (21%). The probable contributory factors for ARF were heavy parasitemia--11 (57.9%), hypotension--six (31.5%), hyperbilirubinemia--seven (36.8%), hemolysis--eight (42%) and DIC--four (21%). Oliguria was present in 47.3%, 13 (68.4%) patients required dialysis. Mortality was noted in 15.7% (3/19) patients.
P. vivax malaria can cause ARF, which occurs more commonly in P. falciparum malaria. Renal ischemia is the dominant pathogenic mechanism that results in acute tubular necrosis. The prognosis of ARF in P. vivax malaria is favorable.
分析间日疟原虫疟疾所致急性肾衰竭的发病率、临床特征及转归。
这是一项对1995年1月至2000年12月期间涂片阳性的间日疟原虫急性肾衰竭患者的回顾性分析。
在577例急性肾衰竭病例中，93例（恶性疟原虫74例，占79.61%；间日疟原虫19例，占20.4%）与复杂型疟疾有关。3.2%（19/577）的患者，16例男性和3例女性，年龄范围为17 - 72岁，平均43.3±13.4岁，病因是间日疟原虫疟疾。13例仅感染间日疟原虫，6例为恶性疟原虫和间日疟原虫混合感染。主要表现为发热（100%）、黄疸（36.8%）、低血压8例（42%）、脑病11例（57.9%）、败血症5例（26.3%）和弥散性血管内凝血4例（21%）。急性肾衰竭的可能促成因素为高疟原虫血症11例（57.9%）、低血压6例（31.5%）、高胆红素血症7例（36.8%）、溶血8例（42%）和弥散性血管内凝血4例（21%）。少尿见于47.3%的患者，13例（68.4%）患者需要透析。15.7%（3/19）的患者死亡。
间日疟原虫疟疾可导致急性肾衰竭，在恶性疟原虫疟疾中更常见。肾缺血是导致急性肾小管坏死的主要致病机制。间日疟原虫疟疾所致急性肾衰竭的预后良好。
