Kute V B, Shah P R, Munjappa B C, Gumber M R, Patel H V, Jain S H, Engineer D P, Naresh V V Sai, Vanikar A V, Trivedi H L
Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Institute of Transplantation Sciences, IKDRC-ITS, Ahmedabad, India.
Indian J Nephrol. 2012 Jan;22(1):33-8. doi: 10.4103/0971-4065.83737.
Acute kidney injury (AKI) is one of the most dreaded complications of severe malaria. We carried out prospective study in 2010, to describe clinical characteristics, laboratory parameters, prognostic factors, and outcome in 59 (44 males, 15 females) smear-positive malaria patients with AKI. The severity of illness was assessed using Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA) score, Multiple Organ Dysfunction Score (MODS), and Glasgow Coma Scale (GCS) scores. All patients received artesunate and hemodialysis (HD). Mean age of patients was 33.63 ± 14 years. Plasmodium falciparum malaria was seen in 76.3% (n = 45), Plasmodium vivax in 16.9% (n = 10), and mixed infection in 6.8% (n = 4) patients. Presenting clinical features were fever (100%), nausea-vomiting (85%), oliguria (61%), abdominal pain/tenderness (50.8%), and jaundice (74.5%). Mean APACHE II, SOFA, MODS, and GCS scores were 18.1 ± 3, 10.16 ± 3.09, 9.71 ± 2.69, and 14.15 ± 1.67, respectively, all were higher among patients who died than among those who survived. APACHE II ≥20, SOFA and MODS scores ≥12 were associated with higher mortality (P < 0.05). 34% patients received blood component transfusion and exchange transfusion was done in 15%. Mean number of HD sessions required was 4.59 ± 3.03. Renal biopsies were performed in five patients (three with patchy cortical necrosis and two with acute tubular necrosis). 81.3% of patients had complete renal recovery and 11.8% succumbed to malaria. Prompt diagnosis, timely HD, and supportive therapy were associated with improved survival and recovery of kidney functions in malarial with AKI. Mortality was associated with higher APACHE II, SOFA, MODS, GCS scores, requirement of inotrope, and ventilator support.
急性肾损伤（AKI）是重症疟疾最可怕的并发症之一。2010年我们开展了一项前瞻性研究，以描述59例（44例男性，15例女性）涂片阳性的疟疾合并AKI患者的临床特征、实验室参数、预后因素及转归。采用急性生理与慢性健康状况评分系统（APACHE）Ⅱ、序贯器官衰竭评估（SOFA）评分、多器官功能障碍评分（MODS）及格拉斯哥昏迷量表（GCS）评分评估疾病严重程度。所有患者均接受青蒿琥酯和血液透析（HD）治疗。患者的平均年龄为33.63±14岁。76.3%（n = 45）的患者为恶性疟原虫疟疾，16.9%（n = 10）为间日疟原虫疟疾，6.8%（n = 4）为混合感染。主要临床特征为发热（100%）、恶心呕吐（85%）、少尿（61%）、腹痛/压痛（50.8%）及黄疸（74.5%）。APACHEⅡ、SOFA、MODS及GCS评分的平均值分别为18.1±3、10.16±3.09、9.71±2.69及14.15±1.67，死亡患者的各项评分均高于存活患者。APACHEⅡ≥20、SOFA及MODS评分≥12与较高的死亡率相关（P<0.05）。34%的患者接受了血液成分输血，15%的患者进行了换血治疗。所需HD治疗的平均次数为4.59±3.03。对5例患者进行了肾活检（3例为局灶性皮质坏死，2例为急性肾小管坏死）。81.3%的患者肾功能完全恢复，11.8%的患者死于疟疾。对于疟疾合并AKI患者，及时诊断、适时HD及支持治疗与生存率提高及肾功能恢复相关。死亡率与较高的APACHEⅡ、SOFA、MODS、GCS评分、血管活性药物需求及呼吸机支持有关。
