Kanodia K V, Shah P R, Vanikar A V, Kasat P, Gumber M, Trivedi H L
Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, Dr. H. L. Trivedi Institute of Transplantation Sciences (ITS) - Smt Gulabben Rasiklal Doshi and Smt Kamlaben Mafatlal Mehta Institute of Kidney Diseases & Research Centre (IKDRC), Civil Hospital Campus, Asarwa, Ahmadabad, Gujarat, India.
Saudi J Kidney Dis Transpl. 2010 Nov;21(6):1088-91.
Malaria has protean clinical manifestations and renal complications, particularly acute renal failure that could be life threatening. To evaluate the incidence, clinical profile, out-come and predictors of mortality in patients with malarial acute renal failure, we retrospectively studied the last two years records of malaria induced acute renal failure in patients with peripheral smear positive for malarial parasites. One hundred (10.4%) (63 males, 37 females) malaria induced acute renal failure amongst 958 cases of acute renal failure were evaluated. Plasmodium (P). falciparum was reported in 85%, P. vivax in 2%, and both in 13% patients. The mean serum creatinine was 9.2 ± 4.2 mg%, and oligo/anuria was present in 82%; 78% of the patients required hemodialysis. Sixty four percent of the patients recovered completely, 10% incompletely, and 5% developed chronic kidney failure; mortality occurred in 21% of the patients. Low hemoglobin, oligo/anuria on admission, hyperbilirubinemia, cerebral malaria, disseminated intravascular coa-gulation, and high serum creatinine were the main predictors of mortality. We conclude that malaria is associated with acute renal failure, which occurs most commonly in plasmodium falciparum infected patients. Early diagnosis and prompt dialysis with supportive management can reduce morality and enhance recovery of renal function.
疟疾有多种临床表现和肾脏并发症，尤其是可能危及生命的急性肾衰竭。为评估疟疾所致急性肾衰竭患者的发病率、临床特征、结局及死亡预测因素，我们回顾性研究了过去两年外周血涂片疟原虫阳性患者中疟疾诱发急性肾衰竭的记录。在958例急性肾衰竭病例中，评估了100例（10.4%）（男性63例，女性37例）疟疾诱发的急性肾衰竭。报告85%为恶性疟原虫，2%为间日疟原虫，13%为两种疟原虫混合感染。平均血清肌酐为9.2±4.2mg%，82%患者出现少尿/无尿；78%的患者需要血液透析。64%的患者完全康复，10%部分康复，5%发展为慢性肾衰竭；21%的患者死亡。低血红蛋白、入院时少尿/无尿、高胆红素血症、脑型疟疾、弥散性血管内凝血和高血清肌酐是死亡的主要预测因素。我们得出结论，疟疾与急性肾衰竭有关，最常见于感染恶性疟原虫的患者。早期诊断并及时透析及支持治疗可降低死亡率并促进肾功能恢复。
