Clinical and histopathological profile of acute renal failure caused by falciparum and vivax monoinfection: an observational study from Bikaner, northwest zone of Rajasthan, India.

ABSTRACT

BACKGROUND & OBJECTIVES: Acute renal failure (ARF) is a known manifestation of severe Plasmodium falciparum (Pf) malaria but recently it has also been observed with P. vivax (Pv) monoinfection. A clinical observational study has been conducted to evaluate the clinical and histopathological profile of ARF in malaria. METHODS: This study was conducted on 288 consecutive cases of malaria with monoinfection (Pf 191 and Pv 97) diagnosed by peripheral blood film examination and rapid card test. ARF was diagnosed as per WHO criterion (serum creatinine >3 mg%). The data were analysed by Standard t-test using ANOVA software. RESULTS: ARF was seen in 52 cases of Pf and 14 cases of Pv malaria. Mean age was 32.58 yr (ranging 15-65; Pf 33.37 and Pv 29.14) and male to female ratio was 21 (Pf 31 and Pv 11). Most of the cases developed ARF within 10 days of onset of the disease. Associated severe manifestations were jaundice (53 cases Pf 44 and Pv 9), cerebral malaria (28 cases Pf 25 and Pv 3), severe anemia (18 cases Pf 17 and Pv 1), hypotension (16 cases Pf 11 and Pv 5), bleeding manifestations (16 cases Pf 14 and Pv 2), multiorgan failure (12 cases Pf 9 and Pv 3) and ARDS (6 cases Pf 5 and Pv 1). Kidney biopsy (16 Pf and 2 Pv) showed acute tubular necrosis (5 Pf and 1 Pv), mesangioproliferative glomerulonephritis (2 Pf) or both (9 Pf and 1 Pv). Haemodialysis was done in 7 (Pf 4 and Pv 3) cases, out of which four survived. Most of the cases (48.49%) recovered within two weeks (range 3-20 days). Total mortality was 27.27% (Pf 28.85% and Pv 21.43%). INTERPRETATION & CONCLUSION: ARF can also be caused by vivax monoinfection with similar clinical and histopathological features although outcome is less severe as compared to falciparum monoinfection.