Bhadauria Dharmendra, Vardhan Harsh, Kaul Anupma, Sharma Raj Kumar, Gupta Amit, Prasad Narayan, Jain Manoj
Assistant Professor.
Senior Resident.
J Assoc Physicians India. 2017 Sep;65(9):28-31.
Acute kidney injury (AKI) is reported to occur in patients with falciparum malaria but not uncommon with vivax malaria. AKI, anemia, thrombocytopenia and jaundice is a recurrent finding in severe malaria and can mimic as thrombotic microangiopathy (TMA). Relationship of malaria with TMA is unclear till date however evidences suggest their association.
METHODS & MATERIAL: We reviewed our electronic database to evaluate relationship of malaria with TMA, of cases of malaria, jaundice and AKI.
4 patients found to have P. vivax malaria and histopathologically confirmed TMA. All had fever, oliguria, jaundice at presentation. The time between onset of symptoms and admission ranged from 7 to 14 days. All had parasitemia at presentation so were treated with Artesuanate. Hemodialysis and Plasmapheresis was done in all patients. On follow-up all patients recovered and asymptomatic urinary abnormality persisting in one patient.
High index of suspicion should be kept for TMA in a patient who has nonrecovering AKI with persistent anemia and thrombocytopenia even after clinical and laboratory evidences of recovery from malaria, as response to plasmapheresis seems excellent in this subset of malarial AKI. There could be a pathogenetic link between P.vivax and TMA though yet to be confirmed in larger studies.
据报道，恶性疟患者会发生急性肾损伤（AKI），而间日疟患者出现AKI的情况也并不罕见。AKI、贫血、血小板减少和黄疸是重症疟疾的常见表现，可能类似血栓性微血管病（TMA）。迄今为止，疟疾与TMA之间的关系尚不清楚，但有证据表明它们之间存在关联。
我们查阅了电子数据库，以评估疟疾与TMA、疟疾合并黄疸和AKI病例之间的关系。
4例患者被诊断为间日疟且经组织病理学确诊为TMA。所有患者就诊时均有发热、少尿和黄疸症状。症状出现至入院的时间为7至14天。所有患者就诊时均有寄生虫血症，因此接受了青蒿琥酯治疗。所有患者均进行了血液透析和血浆置换。随访时，所有患者均康复，1例患者仍有无症状性尿液异常。
对于即使在疟疾临床和实验室检查显示已康复，但仍存在持续性贫血和血小板减少且AKI未恢复的患者，应高度怀疑TMA，因为血浆置换对这部分疟疾相关性AKI患者的疗效似乎很好。间日疟与TMA之间可能存在发病机制上的联系，不过这一点尚未在更大规模的研究中得到证实。
