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Evaluation of Clinical Predictors and Prognostic Indicators of Acute Renal Failure Caused by Different Plasmodium Species in Hospitalized Adult Patients in North West Zone of Rajasthan, India

Bal Kishan Gupta* , Bal Kishan Gupta* , Anjli Gupta** , Shyam Lal Meena*** , Rahul Borhade**** , Hardev Ram Nehra*** , Lalit Mohan Singaria*****

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Indian Journal of Medical and Health Sciences 3(1):p 23-30, Jan-Jun 2016. | DOI: DOI: https://dx.doi.org/10.21088/ijmhs.2347.9981.3116.4

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Abstract

 Aims & Objectives: Recently high incidence of acute renal failure (ARF) in malaria has been reported from various parts of world including India. This study was planned to evaluate the clinical predictors and prognostic indicators of ARF in malaria. Methods: This prospective observational study was done on 60 consecutive confirmed cases of  malaria admitted in the department of medicine. 40 had ARF (study group) and 20 did not (control group). All cases were thoroughly studied for clinical features, laboratory evaluation and outcome. Diagnosis of ARF was made as per WHO criteria. RIFLE criteria were used to stratify severity of acute kidney injury. Prognostic evaluation was also done by different Score system. Results: Out of 40 patients who had ARF  57.6% had P. vivax infection, 32.5% P. falciparum while 10% had mixed infection, thus  we  observed  significantly high number of cases of ARF due to vivax malaria. Clinical predictors for ARF were longer duration of fever, marked chills, severe tiredness, nausea, vomiting, jaundice, altered sensorium, decrease urine, low  GFR , low hemoglobin, high parasite density, TLC, RDW, LDH, bilirubin, SGOT, SGPT, urea, creatinine, APACHE II, SOFA, MODS  and low GCS score. There was no difference in age and sex distribution but rural patients were more affected by ARF. 65% of our cases had non-oliguric ARF. Other manifestations of severe malaria like cerebral malaria (20%), malarial hepatitis (42.5%) and severe anemia (20%) were commonly associated with ARF. 15 cases of ARF needed dialysis. Two patients died both with mixed malaria, RIFLE-F category. Poor prognostic indicators were severe anemia (p<0.01), higher TLC (p<0.01), Blood urea (p<0.001), serum creatinine (p<0.001), SGOT (p=0.001), SGPT (p<0.01), serum bilirubin (p<0.01), parasite density (p<0.05), lower platelet count (p<0.05), and those with higher APACHE II score (p<0.01), SOFA score (p<0.05) and MODS score (p<0.001) and lower GCS score (p<0.001). Conclusions: Our study shows clinical predictors associated with increased risk for development of ARF and poor prognostic indicators associated with serious morbidity and mortality in ARF caused by malaria , if we give due attention to these factors at the time of clinical presentation we can reduce morbidity and mortality due to ARF caused by malaria.

Keywords: Acute Renal Failure; Clinical Predictor; Prognostic Indicators; P. Vivax; P. Falciparum; Mixed Malaria; RIFLE Criteria. 

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DOI: DOI: https://dx.doi.org/10.21088/ijmhs.2347.9981.3116.4

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