Malaria associated acute renal failure--experience from Rourkela, eastern India.

Acute renal failure is a significant complication of falciparum malaria and is associated with increased morbidity and mortality. It occurs rarely in children and is seen frequently among the adults. Malaria associated renal failure may occur as a sole complication or as a component of multiple complications. Some of the patients may have normal urination (non-oliguric) and usually have better prognosis even without renal replacement therapy. Only a few research studies are available from Indian subcontinent on malarial acute renal failure. The present study is a hospital based study from eastern India. Rourkela is situated in the western part of Orissa which contributes a large number of falciparum malaria cases. The study was conducted at the internal medicine department of Ispat General Hospital. The clinical presentation of malaria patients in 2001 were analysed with special emphasis on malarial acute renal failure. The difference between patients with or without renal failure was compared. Seven hundred eighteen patients admitted to Ispat General Hospital in 2001 above the age of 14 years were analysed. Of these, 84 (11.8%) had serum creatinine >3 mg/dl. Seventy-five patients were referred from different hospitals outside the township. The presenting complaints were fever (95%), oliguria (55%); loose motions (25%), and vomiting (51%). Headache was present in only 20% patients. Similarly, hypotension was encountered in about a third. Associated complications were significantly more common among patients having renal failure viz, Jaundice (77 versus 19%; p < 0.001), Cerebral malaria (59 versus 11%; p < 0.001), and hypoglycaemia (p < 0.05). The mortality in presence of acute renal failure was high (p < 0.001). Though malaria renal failure is a burning issue, still scant data is available in the literature, including India. The present study is an attempt to study the patients admitted to a referral hospital. The reason for high mortality is due to presence of multiple complications. The present study indicates that the presence of acute renal failure and jaundice together adversely influences the mortality. Hence, studies may be carried out to find out the reason of this changing trend as well as the methods to ameliorate/manage the situation.