Bodi Joseph M, Nsibu Célestin N, Aloni Michel N, Lukute Guy N, Kunuanuna Thomas S, Tshibassu Pierre M, Pakasa Nestor
Pediatrics Emergency and Intensive Care Unit, University of Kinshasa, Democratic Republic of Congo.
Saudi J Kidney Dis Transpl. 2014 Nov;25(6):1352-8. doi: 10.4103/1319-2442.144326.
Acute renal failure (ARF) is reported in some severe forms of malaria such as black water fever (BWF). It is associated with a high mortality rate and can be managed effectively with adequate renal replacement. A prospective survey of children with dark urine after a malarial infection with Plasmodium falciparum was coupled with a chart review study of patients managed in the past 11 years in the Pediatrics' Kinshasa University Hospital. Eighty-nine cases of ARF were identified, but data from only 63 patients were available, of whom 44 (69.8%) had severe malaria (39 with BWF and 5 with cerebral malaria). The mean age of the patients was 8.2±1.73 years. Of the 39 cases of BWF, an association with quinine ingestion was observed in 32 children (82%). Urea and creatinine levels were elevated in all cases (135.4±88.2 and 3.83±2.81 mg/dL, respectively). Oligo-anuria was observed in 44.4%, severe metabolic acidosis (bicarbonate<15 mEq/L) in 61.5% and hyponatremia (<130 mEq/L) in 33.3%. Peritoneal dialysis was required in 36 patients, including 20 with BWF. The remaining patients were managed with conservative treatment. Twenty-eight children (44.4%), including 20 on dialysis, fully recovered and 14 died (22.2%), including eight cases of BWF. Our study suggests that ARF is commonly associated with BWF in Congolese children. Elevated urea and creatinine and severe metabolic acidosis were observed more often than other clinical/metabolic disturbances. Severe renal impairment remains a significant complication with a high mortality rate in low-resource settings.
急性肾衰竭（ARF）在一些严重的疟疾类型中有所报道，如黑水热（BWF）。它与高死亡率相关，通过适当的肾脏替代治疗可得到有效管理。对感染恶性疟原虫后出现深色尿液的儿童进行了一项前瞻性调查，并结合了对金沙萨大学医院儿科过去11年中管理的患者的病历回顾研究。共识别出89例ARF病例，但仅有63例患者的数据可用，其中44例（69.8%）患有严重疟疾（39例为BWF，5例为脑型疟疾）。患者的平均年龄为8.2±1.73岁。在39例BWF病例中，32名儿童（82%）观察到与奎宁摄入有关。所有病例的尿素和肌酐水平均升高（分别为135.4±88.2和3.83±2.81mg/dL）。44.4%的患者出现少尿或无尿，61.5%的患者出现严重代谢性酸中毒（碳酸氢盐<15mEq/L），33.3%的患者出现低钠血症（<130mEq/L）。36例患者需要进行腹膜透析，其中包括20例BWF患者。其余患者采用保守治疗。28名儿童（44.4%），包括20名接受透析的儿童，完全康复，14名儿童（22.2%）死亡，其中包括8例BWF病例。我们的研究表明，在刚果儿童中，ARF通常与BWF相关。与其他临床/代谢紊乱相比，尿素和肌酐升高以及严重代谢性酸中毒更为常见。在资源匮乏的环境中，严重肾功能损害仍然是一种具有高死亡率的重大并发症。
