Study of epidemiological profile, clinico-biochemical spectrum and prognosis of malaria induced renal dysfunction in paediatrics age group

Abstract

INTRODUCTIONMalaria remains a serious health problem in many parts of the world. It causes high morbidity and claims many lives in developing countries each year. Humans are generally infected by four species of malaria parasites. 1Malarial acute kidney injury is commonly found in nonimmune adults and older children with falciparum malaria and occasionally with Plasmodium vivax. Occurrence of malaria induced acute kidney injury in severe falciparum malaria is quite common in Southeast Asia and Indian subcontinent where intensity of malaria transmission is usually low.2 Major manifestations of severe malaria in children are cerebral malaria, severe ABSTRACTBackground: Aim of current study was to assess the epidemiology, clinico-biochemical spectrum and prognosis of acute malaria induced nephropathy in children. Methods: This was a prospective study conducted in the period from November 2013 to November 2014 in children suffering from acute malaria induced acute kidney injury. Malaria was confirmed by peripheral blood film or Rapid malaria test and detailed clinical evaluation and investigations were carried out to find multi-organ afflictions with special emphasis on renal involvement. Results: Out of total 200 cases with malaria recorded in our hospital 60 (30%) cases had acute malaria induced acute kidney injury caused by Plasmodium vivax in 45 (75%), Plasmodium falciparum in 3 (5%) and mixed infection in 12 (20%) cases. Thirty percentage of cases had come from Sri Ganganagar district making it the most common geographical region in our study. The sex ratio was 3.6:1. Most common age group was 5-10 year age group contributing to 45% of the cases. Fever and oliguria being the most common presentation and was observed in all the cases followed by vomiting, pain abdomen and hypotension which was present in 33%, 32% and 20% of the cases respectively. Oliguria was present in all the cases in which 24 (40%) cases had urine output <1 ml/kg/hour, 36 (60%) patient had urine output <0.5 ml/kg/hour with G.F.R >25 ml/min/1.73m 2 and <25 ml/min/1.73m 2 seen in 40 (66%) and 3 (5%) cases respectively. Fifty five patients (91.66%) had S. creatinine between 1.5-3 mg/dl and only 5 patients (8.33%) had serum creatinine >3 mg/dl. 75% cases recovered in <5 days and 4 patients expired, 2 due to respiratory failure and 2 due to MODS and cerebral malaria. expired cases two were died due to respiratory failure, other two were died due to multiorgan failure and cerebral malaria. Conclusions: The spectrum of renal involvement due to malaria is variable ranging from mild derangement of renal functions to advanced stage of renal dysfunction which needs immediate dialysis. Severe renal involvement was mainly seen with P. falciparum but in our study it is mainly seen with P. vivax infection.

A study on outcome of malaria and acute gastroenteritis induced acute kidney injury requiring hemodialysis

“…As per the result of Barsoum RS jaundice is the most common association with malarial ARF (MARF), occurring in more than 75% of cases. 14 As in present study, fever was present in 100% in 124 patients of malaria due to AKI in study done by Naqvi R et al 2003; similarly, 100% patient had fever in a study involving 200 patients by Panwar S et al 15,16 In study by Wasnik PN et al in 80 confirmed cases of Falciparum malaria fever was the most common symptom observed in all patients and majority of patients presented in the hospital within a week of onset of symptoms. 17 AGE patients presented with diarrhoea (75% males and 75% females) vomiting (83.33% males and 75% females), fever (16.67% males only), decreased urine output (100% males and females), pedal oedema (33.33% males and 25% females).…”

Study clinical response and parasite clearance response to Artemisinins in severe malaria in children

“…A study by Panwar S et al has observed P. vivax as important cause of nephropathy. 17 But in the present study all oliguric patients were P. falciparum severe malaria cases. Hematuria was a less common (11.1% cases) finding in our study.…”

Biochemical and clinical variations among severe Plasmodium Vivax malaria cases: A prospective study

“…In India, about 70% of the infections reported are due to P. vivax; 25-30% due to P. Falciparum and 4-8% are due to mixed infections. P. malariae is responsible for less than 1% of infections in India [13].…”