title: A case series of falciparum malaria-induced acute renal failure.
abstract: Falciparum malaria is a disease of tropical climates which affects 270 million people annually and has an overall mortality of 1%. While the incidence of acute renal failure in malaria is less than 1%, mortality is reported to be as high as 45% in those with renal failure. We report the clinical course and outcome in 5 patients with falciparum malaria-induced acute renal failure treated at the Singapore General Hospital between June and July 1997. All 5 males, with mean age of 35.2 +/- 13.1 years, were admitted with history of fever and reported travel to a known malarious zone. Mean laboratory parameters upon admission included serum creatinine 725 +/- 515 mumol/L and serum urea 47 +/- 31 mmol/L. Three patients with hypotension on admission were started on haemodiafiltration, of whom 2 were subsequently converted to haemodialysis as their haemodynamics improved. Two remaining patients were started on intermittent bicarbonate haemodialysis. The overall mortality in our series was 20%, with 1 patient having died of complications of adult respiratory distress syndrome, disseminated intravascular coagulation and multiorgan failure. The remaining 4 survived and recovered their renal function. The single patient mortality occurred in the patient with admission serum creatinine of 1632 mumol/L, a value significantly higher than that of the 4 patients who survived (mean serum creatinine, 499 +/- 106 mumol/L, P < 0.002). These results suggest that falciparum malaria associated with acute renal failure is associated with a high morbidity, but early presentation and intervention with appropriate antimalarial and renal replacement therapy is associated with improved survival and recovery of renal function.
authors.affiliation: Department of Renal Medicine, Singapore General Hospital.
authors.forename: S
authors.initials: S
authors.lastname: Zinna
authors.forename: A
authors.initials: A
authors.lastname: Vathsala
authors.forename: K T
authors.initials: KT
authors.lastname: Woo
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage; D001803:Blood Transfusion; D003131:Combined Modality Therapy; D017809:Fatal Outcome; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011803:Quinine / Q000008:administration & dosage; D006435:Renal Dialysis; D012189:Retrospective Studies
chemical_list: D000962:Antimalarials; D011803:Quinine