ACUTE RENAL FAILURE IN SEVERE MALARIA. Dr Saroj K Mishra Dr Kishore C Mahanta Ispat General Hospital, Rourkela Orissa India. INTRODUCTION. Malaria is one of top 10 killer diseases in world ARF occurs in <1% of pf malaria, but mortality up to 45%
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Dr Saroj K Mishra
Dr Kishore C Mahanta
Ispat General Hospital, Rourkela Orissa India
Two different settings-
Often associated with poor prognosis.
b) Present as a sole complication at a later stage of the course, when other complications subsided or treated,
Often associated with recovery.
1.Effect of pRBC on microcirculation- knob like processes formation on surface of RBC which helps in anchoring the endothelium
Cytoadherence- due to thrombospondin formation from vascular endothelium- specific to pf ( not in pv/pm) so ARF only in pf.
Loss of deformability of pRBC according to need of microcirculation- slugish circulation- renal ischemia
2.Hypovolumia may occur due to Fever (hyperpyrexia), sweating, decreased intake of fluid, vomiting etc.
4.Increased plasma viscosity due to infection
5.Release of chemical mediators- TNF,cachectin, cytokines, interleukines etc causes- vasoconstriction, increased vascular permiability, catecholamine release(SIADH ) hemoconcentrarion, shock & tubular necrosis
6.Hyperbilirubinaemia due to hemolysis, Black water fever in G6 PD deficiency patients is also associated with ARF
Two subsets of presentations-
c) very high jaundice d) prolonged dehydration e) on NSAID therapy
Fluid challenge –
20ml/kg of Normal saline over one hr.
Monitor for fluid overload after each 200ml by- Chest auscultation, JVP,CVP at 0 & +5
Urine output should be 20ml/hour
Iv loop diuretic- Inj Furosemide in incremental dose 40-100-200-400mg at ½ hour interval
Inj dopamine slow iv infusion at
2.5 to 5mcg/kg/min
Avoid Nephrotoxic drug in ARF suspects-
- Can be given safely in pregnancy & ARF
- Initial dose of qunine -10mg/kg 8hrly
- Reduction after 48 hrs
Laboratory: Rising creatinine, Hyperkalemia,
(K >6.5), Acidosis(HCO3 <15meq/l)
- Efficient method
- Only in selected centers
- Lag time