Prakash J, Gupta A, Kumar O, Rout S B, Malhotra V, Srivastava P K
Department of Nephrology, Indira Gandhi Institute of Medical Sciences, Patna, India.
Nephrol Dial Transplant. 1996 Dec;11(12):2414-6. doi: 10.1093/oxfordjournals.ndt.a027206.
Twenty-six cases (4.8%) from a total of 540 patients with acute renal failure (ARF) of diverse aetiology had ARF in association with falciparum malaria. Their ages ranged from 15 to 85 years (mean 31.2). Urinary sediment abnormalities and proteinuria (less than 1 g/24 h) were observed in 15 (57.7%) cases. The probable underlying factors leading to ARF were: volume depletion 17 (65.3%), intravascular haemolysis 8 (30.8%), hyperparasitaemia 8 (30.8%), cholestatic jaundice 6 (23%), and hypotension 5 (19.2%). Dialysis therapy was required in 15 patients (57.7%) as they had severe renal failure, and the remaining 11 patients improved with supportive measures. All patients received antimalarial therapy. The clinical course of ARF was consistent with acute tubular necrosis in 20 patients. Six cases were subjected to percutaneous renal biopsy. One patient showed histological features of necrotizing glomerulonephritis along with acute tubulointerstitial nephritis. The biopsies in the other five patients showed features of acute tubular necrosis in three, and acute interstitial oedema with patchy tubular necrosis in two. The mortality rate was 30.8%. Thus falciparum malaria, which has been an important cause of ARF in certain highly endemic zones of India, is showing an increasing prevalence in other parts such as Eastern Uttar Pradesh due to an imbalance between the increasing population and inadequate sanitary facilities, which further worsen during floods.
在540例病因各异的急性肾衰竭（ARF）患者中，有26例（4.8%）的ARF与恶性疟原虫疟疾相关。他们的年龄在15至85岁之间（平均31.2岁）。15例（57.7%）患者出现尿沉渣异常和蛋白尿（少于1g/24小时）。导致ARF的可能潜在因素有：容量耗竭17例（65.3%）、血管内溶血8例（30.8%）、高疟原虫血症8例（30.8%）、胆汁淤积性黄疸6例（23%）以及低血压5例（19.2%）。15例（57.7%）患者因严重肾衰竭需要透析治疗，其余11例患者通过支持治疗病情好转。所有患者均接受了抗疟治疗。20例患者的ARF临床病程符合急性肾小管坏死。6例患者接受了经皮肾活检。1例患者表现出坏死性肾小球肾炎以及急性肾小管间质性肾炎的组织学特征。其他5例患者的活检结果显示，3例为急性肾小管坏死，2例为急性间质性水肿伴局灶性肾小管坏死。死亡率为30.8%。因此，恶性疟原虫疟疾在印度某些高流行区一直是ARF的重要病因，由于人口增长与卫生设施不足之间的失衡，在北方邦东部等其他地区的患病率正在上升，在洪水期间情况会进一步恶化。
