Renal Dysfunction in Malaria Infection Around Navi Mumbai

Abstract

Introduction: Acute renal failure (ARF) is seen mostly in Plasmodium falciparum infection, but P. vivax and P. malariae can cause renal impairment rarely. Malarial ARF is commonly found in adults and older children with falciparum malaria. Material & Methods: Ninety five patients from Pad. Dr. D Y Patil Hospital and Research Centre, Navi Mumbai, were included in this study during July-Aug 2010. Out of 95 patients 38 patients are control, 10 patients infected by P. falciparum, 36 patients infected by P. vivax and 11 are mix infection of P. falciparum & P. vivax. All patients' diagnosis is confirmed by clinical examination as well as peripheral blood smear. Results: Renal involvement present as electrolyte abnormality as Hyponatraemia, Oliguria, Uraecemia and jaundice. Acute Renal Failure (ARF) occurs as a complication of P. falciparum malarial infection in less than 1% of cases, but the mortality reported up to 40%. Malarial ARF is diagnosed when serum creatinine level greater than 3 mg/dL and/or urinary output is less than 400 ml in 24 hours. The serum concentrations of Creatinine, urea, proteins ( Total proteins & albumin), Bilirubin (conjugated and total bilirubin) in malaria patients were significantly higher (p<0.05) than those of malaria free individuals. We conclude that renal dysfunction, acute renal failure and liver dysfunction are clinical features of malaria Conclusion: In spite of several researches and ultramodern techniques, mechanism of malarial ARF and its effective management has remained unclear. In many cases reversal of renal dysfunction takes place may be due to biotransformation of antigen and response of immune system. In addition, the literature is almost silent on the mechanism of recent increase in incidence of ARF and multiple complications specifically around coastal regions in India.