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[急性肾衰竭与恶性疟原虫疟疾:一例报告]

[Acute renal failure and Plasmodium falciparum malaria: a case report].

作者信息

Kissou S A, Cessouma R, Barro M, Traoré H, Nacro B

机构信息

Département de pédiatrie, CHU Sourô SANOU, Bobo-Dioulasso, Burkina Faso.

出版信息

Arch Pediatr. 2012 Jan;19(1):34-7. doi: 10.1016/j.arcped.2011.10.007. Epub 2011 Nov 18.

Abstract

Malaria is an endemic disease caused by one of the several Plasmodium species. Severe malaria is mainly due to Plasmodium falciparum in highly endemic areas. Acute renal failure (ARF) is a criterion of malaria severity as defined by WHO. Often observed in adults, particularly in India and Southeast Asia, this complication remains a rare complication of malaria in children. We report a case of oliguric ARF that occurred in a 7-year-old girl a few days after the onset of fever. The vascular obstruction by parasitized erythrocytes often causing tubular necrosis is the primary mechanism of renal failure. As a possible diagnosis, hemolytic uremic syndrome, renal failure and quartan hemoglobinuric nephropathy are other possible causes of renal failure in malaria. Renal biopsy, which was not performed in our patient, would have been a great help, but was not available. The outcome was favorable with recovery of renal function after 3 weeks of diuretic therapy. This development is not always the rule and the prognosis depends on early diagnosis and treatment options.

摘要

疟疾是由几种疟原虫中的一种引起的地方性疾病。在高度流行地区,重症疟疾主要由恶性疟原虫所致。急性肾衰竭(ARF)是世界卫生组织定义的疟疾严重程度的一项标准。这种并发症在成人中较为常见,尤其是在印度和东南亚,但在儿童疟疾中仍然是一种罕见的并发症。我们报告一例7岁女孩在发热几天后出现少尿性急性肾衰竭的病例。寄生红细胞引起的血管阻塞常导致肾小管坏死,这是肾衰竭的主要机制。作为一种可能的诊断,溶血性尿毒症综合征、肾衰竭和三日疟血红蛋白尿性肾病是疟疾肾衰竭的其他可能原因。我们的患者未进行肾活检,肾活检本会有很大帮助,但无法进行。经过3周利尿治疗后肾功能恢复,结果良好。这种情况并非总是如此,预后取决于早期诊断和治疗选择。

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