Department of Nephrology, University College Hospital, Galway, Republic of Ireland.
Immune Receptors and Renal Immunopathology, INSERM Unit 1149, Centre de Recherche sur l'Inflammation, Université Sorbonne Paris Cité, Paris, France.
Malar J. 2019 Mar 1;18(1):58. doi: 10.1186/s12936-019-2674-5.
Malarial acute renal failure (MARF) is a component of the severe malaria syndrome, and complicates 1-5% of malaria infections. This form of renal failure has not been well characterized by histopathology.
A 44 year-old male presented to the emergency department with a 5-day history of fever and malaise after returning from Nigeria. A blood film was positive for Plasmodium falciparum. His creatinine was 616 µmol/L coming from a normal baseline of 89 µmol/L. He had a urine protein:creatinine ratio of 346 mg/mmol (4.4 g/L). He required dialysis. A renal biopsy showed acute interstitial nephritis with podocyte foot-process effacement. He was treated with artesunate and his renal function improved. At 1 year follow-up his creatinine had plateaued at 120 µmol/L with persistent low-grade proteinuria.
Acute interstitial nephritis and podocyte foot-process effacement might be under-recognized lesions in MARF. Studying the mechanisms of MARF could give insight into the immunopathology of severe malaria.
疟疾急性肾衰竭（MARF）是严重疟疾综合征的一个组成部分，占疟疾感染的 1-5%。这种类型的肾衰竭在组织病理学上尚未得到很好的描述。
一名 44 岁男性，从尼日利亚返回后出现发热和乏力 5 天，到急诊就诊。血片检查显示恶性疟原虫阳性。他的肌酐为 616µmol/L，而正常基线值为 89µmol/L。他的尿蛋白/肌酐比值为 346mg/mmol（4.4g/L）。他需要透析。肾活检显示急性间质性肾炎，伴有足细胞足突融合。他接受了青蒿琥酯治疗，肾功能有所改善。在 1 年的随访中，他的肌酐稳定在 120µmol/L，持续存在低度蛋白尿。
急性间质性肾炎和足细胞足突融合可能是 MARF 中被低估的病变。研究 MARF 的发病机制可以深入了解严重疟疾的免疫病理学。
