Management of malaria with acute renal failure

Abstract

In parts of the world, such as Africa, where Plasmodium falciparum is endemic and its transmission is stable, severe malaria affects mainly children. Cerebral malaria and severe anaemia are common but multi-organ failure involving the kidneys or liver is very rare. Surviving children develop immunity and thus as adults rarely develop severe disease III. In contrast, in other tropical countries where transmission of P. falciparum is unstable and the risk of infection low, severe malaria can occur at any age. Severe malaria is defined as parasitaemia greater than 5% or vital organ dysfunction. Acute renal failure (ARF) is a common complication of severe falciparum malaria in non-immune individuals. At the Bangkok hospital for Tropical Disease, 5,210 patients with falciparum malaria were admitted during the period 1991-1997 of whom 112 patients (2.12%) had ARF. In a recent study of 560 cases of severe adult malaria in Vietnam, 28% of patients had renal failure on admission and 41% at some stage, with 14% overall requiring dialysis [2]. Overall, however, ARF is not a common complication of malaria. During the Vietnam war, the reported incidence was 19 cases in 3,000 malarial admissions in 1965/6 and 8 of 2003 admissions n 1966 [3,4].