Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
Ren Fail. 2013 Jul;35(6):801-5. doi: 10.3109/0886022X.2013.800808. Epub 2013 Jun 3.
The aim of this prospective study was to determine the outcome of patients suffering from malaria with acute renal dysfunction.
All adult patients of laboratory-proven malaria with acute kidney injury (AKI) admitted during the period of May 2010 to June 2011 were included. Patient characteristics, physical examination findings, and laboratory parameters were recorded. Patient outcome was assessed in terms of peak serum creatinine level, duration of hospital stay, need for dialysis, and in-hospital mortality rate. Surviving patients were followed up for 3 months to determine progression to chronic kidney disease.
This study enrolled 101 patients of malarial AKI. Mean age was 33.70 ± 15.39 years. Oliguric AKI was observed in 44.6% cases. Mean duration of hospital stay was 8.75 ± 7.60 days. Renal replacement therapy was required in 36.6% patients. Ten (9.9%) patients succumbed to illness during hospital stay. Majority of deaths occurred shortly after admission. Mortality risk was significantly associated with raised LDH (p = 0.019), lower hemoglobin level (p = 0.015), raised aspartate transaminases (p < 0.001), and elevated alanine transaminases (p = 0.016). Cerebral malaria was an important determinant of mortality (p = 0.002). Renal parameters, including severity of renal dysfunction and need for dialysis, were not associated with mortality risk. Among 91 survivors, 79 patients completed a 3-month follow-up and all of them had normalization of renal function.
We observed 9.9% in-hospital mortality rate in the study cohort. Cerebral malaria was an important risk factor for mortality in malarial AKI patients. Severity of renal dysfunction did not correlate with the mortality risk in our study.
本前瞻性研究旨在确定患有急性肾功能障碍的疟疾患者的预后。
纳入 2010 年 5 月至 2011 年 6 月期间因实验室确诊的疟疾合并急性肾损伤（AKI）而入院的所有成年患者。记录患者特征、体格检查结果和实验室参数。根据血清肌酐峰值水平、住院时间、透析需求和住院死亡率评估患者预后。对存活患者进行 3 个月随访，以确定是否进展为慢性肾脏病。
本研究纳入了 101 例疟原虫性 AKI 患者。平均年龄为 33.70±15.39 岁。44.6%的患者出现少尿性 AKI。平均住院时间为 8.75±7.60 天。36.6%的患者需要肾脏替代治疗。10（9.9%）例患者在住院期间死亡。大多数死亡发生在入院后不久。死亡率风险与升高的 LDH（p=0.019）、较低的血红蛋白水平（p=0.015）、升高的天门冬氨酸转氨酶（p<0.001）和丙氨酸转氨酶升高（p=0.016）显著相关。脑型疟疾是死亡的重要决定因素（p=0.002）。包括肾功能不全严重程度和透析需求在内的肾脏参数与死亡率风险无关。在 91 例幸存者中，79 例完成了 3 个月的随访，所有患者的肾功能均恢复正常。
我们观察到研究队列的住院死亡率为 9.9%。脑型疟疾是疟疾合并 AKI 患者死亡的重要危险因素。在本研究中，肾功能不全的严重程度与死亡率风险无关。
