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Prognosis of malaria associated severe acute renal failure in children
1Department of Medicine, Faculty of Medicine, Sana'a University, Republic of Yemen.
Insights
Severe acute renal failure in children with Falciparum Malaria is a critical condition with a high mortality rate. Younger children, lower blood pressure, and delayed referral were associated with increased risk of death.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- Falciparum Malaria can cause severe acute renal failure in children, requiring intensive management.
- Pediatric acute renal failure (ARF) secondary to malaria presents significant challenges in resource-limited settings.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of children requiring dialysis for severe acute renal failure due to Falciparum Malaria.
- To identify factors associated with mortality in this pediatric patient cohort.
Main Methods:
- A prospective observational study was conducted between January and December 1996.
- Sixty-four children with severe acute renal failure secondary to Falciparum Malaria received anti-malarial therapy, supportive care, and peritoneal dialysis.
- Clinical data and outcomes were compared between survivors and non-survivors.
Main Results:
- The overall mortality rate was 43.8% (28 out of 64 children).
- Children who died were significantly younger, presented with higher plasma creatinine and bilirubin levels, and had lower blood pressure and hemoglobin levels.
- Delayed time from diagnosis to referral and lower urine output were also significantly associated with mortality.
Conclusions:
- Severe acute renal failure in children with Falciparum Malaria has a high mortality rate.
- Younger age, lower blood pressure, higher plasma creatinine, and delayed referral are critical indicators for poor prognosis in pediatric Falciparum Malaria patients requiring dialysis.
Abstract:
Between January and December 1996, we observed 64 children (mean age 8.3 years range 4.2 to 11.2 years) who required dialysis for severe acute renal failure secondary to Falciparum Malaria. All received anti malarial therapy and other supportive therapy as well as peritoneal dialysis. Out of these 28 died (43.8%). The children who died (Group I) compared to those who survived (Group II) differed significantly in age (mean +/- SD) (7.2 +/- 1.3 years vs. 9.2 +/- 2.1 years P < 0.05), plasma creatinine at presentation (645 +/- 104 mumol/L vs. 438 +/- 87 mumol/L P < 0.05), plasma bilirubin (2.1 +/- 0.3 mg/dL vs. 1.2 +/- 0.2 mg/dL P > 0.02) systolic BP (50 +/- 11 mmHg vs. 90 +/- 12 mmHg P0 < 0.01), diastolic BP (20 +/- 4 mmHg vs. 60 +/- 9 mmHg P < .01) .Hb level 5.3 +/- 0.4 g/dL vs. 8 +/- 1.3 gm/dL P < .02), time from diagnosis to referral (5.3 +/- 1.3 days vs. 8.9 +/- 2.1 days P < .05) and urine output (200 +/- 49 mL/24 h vs. 600 mL +/- 131 mL P < .01). There was no significant difference in gender, alanine transaminase (ALT) level, degree of fever, plasma Na or plasma K. Diarrhea was present in 29% of the children who died and in only 11% of those who survived (P > 0.05) and splenomegaly was found in 3% and 18% respectively (PO > .05).