title: Acute renal failure in patients with severe falciparum malaria.
abstract: Since 1988 in this referral center for severe cases of malaria for South Vietnam, a specialist team has managed malaria-associated renal failure (MARF) with peritoneal dialysis, and the mortality rate of MARF has fallen from 75% (78 of 104) to 26% (27 of 104) (P < .0002). Sixty-four patients with MARF (of whom 12 died) were compared to 66 patients with severe malaria whose serum creatinine levels remained < 250 mumol/L (six died). MARF had the clinical and biochemical features of acute tubular necrosis and was significantly associated with liver dysfunction (P < .05). A fatal outcome was associated significantly with anuria, a short history of illness, multisystem involvement, and high parasitemia. Most patients died from complications related to renal failure. Recovery of renal function was unrelated to parasitemia or hemoglobinuria; the median (range) time until urine output exceeded 20 mL/(kg.d) was 4 (0-19) days, and the time (mean +/- SD) for serum creatinine level to return to normal was 17 +/- 6 days. MARF can be managed effectively by prompt and careful peritoneal dialysis, but more effective dialysis or diafiltration might reduce the mortality rate further.
authors.affiliation: Wellcome Clinical Research Unit, Cho Quan Hospital, Ho Chi Minh City, Vietnam.
authors.forename: T T
authors.initials: TT
authors.lastname: Trang
authors.forename: N H
authors.initials: NH
authors.lastname: Phu
authors.forename: H
authors.initials: H
authors.lastname: Vinh
authors.forename: T T
authors.initials: TT
authors.lastname: Hien
authors.forename: B M
authors.initials: BM
authors.lastname: Cuong
authors.forename: T T
authors.initials: TT
authors.lastname: Chau
authors.forename: N T
authors.initials: NT
authors.lastname: Mai
authors.forename: D J
authors.initials: DJ
authors.lastname: Waller
authors.forename: N J
authors.initials: NJ
authors.lastname: White
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data