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Acute renal failure in falciparum malaria
M Segasothy1, M Swaminathan, N C Kong
1Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur.
The Medical Journal of Malaysia
|December 1, 1994
Summary
Cerebral malaria can cause acute kidney injury, specifically acute tubular necrosis, even without red blood cell breakdown. Prompt treatment with quinine and dialysis can lead to recovery.
Area of Science:
- Nephrology
- Infectious Diseases
- Pathology
Background:
- Cerebral malaria is a severe complication of Plasmodium falciparum infection.
- Acute kidney injury (AKI) is a known complication of severe malaria.
- The exact mechanisms of AKI in cerebral malaria are not fully understood.
Observation:
- Two patients presented with cerebral malaria, high parasite counts, and jaundice.
- Both patients developed rapidly rising blood urea and serum creatinine levels, indicating AKI.
- No signs of intravascular hemolysis were detected in either patient.
Findings:
- Renal biopsies confirmed acute tubular necrosis (ATN) as the cause of AKI.
- The absence of intravascular hemolysis suggests ATN is not solely due to red blood cell destruction.
- Treatment with intravenous quinine and hemodialysis resulted in recovery for both patients.
Implications:
- This case series highlights ATN as a significant cause of AKI in cerebral malaria.
- It suggests that AKI in this context may occur through mechanisms beyond hemolysis.
- Effective management involves prompt antimalarial therapy and supportive renal care, including dialysis.