Relationship of hepatic and renal dysfunction with haemorrheological parameters in Plasmodium falciparum malaria

The present study was designed to assess hepatic and renal dysfunction in Plasmodium falciparum malaria, and evaluate if such abnormalities had any bearing with the hemorrheological dysfunction.

Sixty consecutive patients of Plasmodium falciparum malaria with hepatic and renal dysfunction (Group A) and twenty consecutive cases of uncomplicated falciparum malaria (Group B) were studied. Patients with past history of alcoholism, jaundice, chronic renal failure, bleeding diathesis or coagulopathy were excluded from the study. Laboratory investigations done were liver and renal function tests, complete blood count and coagulation profile. The data collected was analysed to inter - correlate parameters of hepatic, renal and hemorrheological dysfunction.

In Group A, all had rigor and chill, icterus while 57% had oliguria and hepatomegaly, 37% splenomegaly, with less than 2% having overt bleeding diathesis. On evaluation, in Group A, 57% had acute renal failure, mean value of bilirubin was 13.91 (+/- 12.53) mg/dL, ALT 76.92 (+/- 37.48) IU/ml, AST 135.32 (+/- 97.33) IU/ml, mean PT was 13.03 (+/- 2.22) seconds, mean aPTT was 31.69 +/- 6.76 seconds, FDP by D-dimer was raised in 53% and LDH was raised in 78% respectively. In Group B mean PT was 11.93 (+/- 1.51) seconds, mean APTT was 29.39 +/- 2.89 seconds and FDP by D-dimer was raised in 30% respectively. Thrombocytopenia was seen in 26% cases in Group A and 15% cases in Group B. On analysis, in Group B, there was statistically significant negative correlation of total platelet count with serum AST (p = .010) and serum ALT (p = .036), serum ALP with BT (p = .036), but positively with CT (p = .006) and aPTT (p = .036). In Group A, serum bilirubin was found to have significant negative correlation with haemoglobin (p = .019),positive correlation with aPTT (p = .037), urea (p = .000) and serum creatinine (p = .000), serum ALP Positively with serum urea (p = .025) and serum creatinine (p = .037), serum urea negatively with haemoglobin(p = .015), so also did serum creatinine (p = .025),prothrombin time positively with serum urea(p = 0.037) and serum creatinine (p = 0.013), serum FDP positively with serum urea (p = 0.038) and serum creatinine (p = 0.022), bleeding time positively with serum AST(p = .002).

Despite less than 2% of patients in Group A having clinically overt bleeding diathesis, raised FDP (53%), prolonged aPTT (67%), low total platelet count (26%) and anemia (87%) were found in a significant number of patients, suggesting subclinical DIC. Therefore patients with Plasmodium falciparum malaria have high incidence of subclinical haemorrheological disorders which do not amount to overt DIC but adversely affect renal function contributing to acute renal failure.