Mishra Saroj K, Das Bhabani Shankar
Internal Medicine, Ispat General Hospital, Orissa, India..
Institute of Life Sciences, Indian Council of Medical Research, Bhuabaneswar, Orissa, India.
Semin Nephrol. 2008 Jul;28(4):395-408. doi: 10.1016/j.semnephrol.2008.04.007.
Malaria is a major public health problem in tropical countries. About 500 million people suffer from malaria, leading to death in 1 to 3 million cases. Acute kidney injury (AKI) is one of the most dreaded complications of severe malaria. As per World Health Organization criteria, acute renal failure (serum creatinine level, > or =3 mg/dL or > or =265 micromol/L) occurs as a complication of Plasmodium falciparum malaria in less than 1% of cases, but the mortality rate in these cases may be up to 45%. It is more common in adults than children. Renal involvement varies from mild proteinuria to severe azotemia associated with metabolic acidosis. It may be oliguric or nonoliguric. AKI may be present as a component of multi-organ dysfunction or as a lone complication. The prognosis in the latter is generally better. Several pathogenic mechanisms interplay for the clinical manifestation. The predominant lesions are acute tubular necrosis and mild proliferative glomerulonephropathy. These patients do not progress to chronic kidney disease. The management of malaria-induced AKI includes appropriate antimalarials (parenteral artesunate or quinine), fluid electrolyte management, and renal replacement therapy at the earliest. The use of diuretics should be avoided.
疟疾是热带国家的一个主要公共卫生问题。约有5亿人感染疟疾，其中100万至300万人死亡。急性肾损伤（AKI）是重症疟疾最可怕的并发症之一。根据世界卫生组织的标准，急性肾衰竭（血清肌酐水平≥3mg/dL或≥265μmol/L）作为恶性疟原虫疟疾的并发症，发生率不到1%，但这些病例的死亡率可能高达45%。在成人中比儿童更常见。肾脏受累情况从轻度蛋白尿到伴有代谢性酸中毒的严重氮质血症不等。可能是少尿型或非少尿型。AKI可能是多器官功能障碍的一部分，也可能是单独的并发症。后者的预后通常较好。多种致病机制相互作用导致临床表现。主要病变是急性肾小管坏死和轻度增生性肾小球肾炎。这些患者不会发展为慢性肾脏病。疟疾所致AKI的治疗包括尽早使用适当的抗疟药（静脉注射青蒿琥酯或奎宁）、液体电解质管理以及肾脏替代治疗。应避免使用利尿剂。
