Renal dysfunction in falciparum--malaria is detected more often when assessed by serum concentration of cystatin C instead of creatinine.
OBJECTIVE
To estimate the frequency of renal dysfunction in falciparum malaria by serum concentration of cystatin C, a new sensitive indicator of the glomerular filtration rate (GFR).


METHODS
Retrospective study of stored sera and patient files. Assessment of renal function by serum concentration of creatinine and cystatin C and comparison of the results from both indicators of GFR.


RESULTS
A total of 108 adult patients with falciparum malaria were included in the study. Concentration of creatinine and cystatin C correlated well (r = 0.706; P < 0.001). Elevated cystatin C was more frequent than elevated creatinine (54.6%vs. 20.4%; P < 0.001). Patients older than 50 years developed renal dysfunction more often (P < 0.05) than younger ones. Results from cystatin C and creatinine were concordant in 63 (58.3%) and contradictory in 45 (41.6%) cases. Four (3.7%) patients had elevated creatinine but normal cystatin C levels, hence 63 patients (58.3%) showed elevation of at least one indicator of GFR. The frequency of elevated cystatin C and elevated creatinine was unrelated to body weight, gender or bilirubin level.


CONCLUSIONS
The prevalence of impaired renal function in patients with falciparum malaria seems to have been underestimated in the past. Using a sensitive marker, 55% of the patients have a reduced GFR.
Günther
A
A
Institut für Tropenmedizin, Berlin, Germany. andreas.gunther@gmx.de
Burchard
G D
GD
Slevogt
H
H
Abel
W
W
Grobusch
M P
MP
D000293:Adolescent; D000328:Adult; D003404:Creatinine / Q000097:blood*; D055316:Cystatin C; D015891:Cystatins / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D016778:Malaria, Falciparum / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins; D003404:Creatinine