ACUTE-RENAL-FAILURE IN FALCIPARUM-MALARIA - INCREASING PREVALENCE IN SOME AREAS OF INDIA - A NEED FOR AWARENESS

Twenty-six cases (4.8%) from a total of 540 patients with acute renal failure (ARF) of diverse aetiology had ARF in association with falcipa rum malaria. Their ages ranged from 15 to 85 years (mean 31.2). Urinar y sediment abnormalities and proteinuria (less than 1 g/24 h) were obs erved in 15 (57.7%) cases. The probable underlying factors leading to ARF were: volume depletion 17 (65.3%), intravascular haemolysis 8 (30. 8%), hyperparasitaemia 8 (30.8%), cholestatic jaundice 6 (23%), and hy potension 5 (19.2%). Dialysis therapy was required in 15 patients (57. 7%) as they had severe renal failure, and the remaining 11 patients im proved with supportive measures. All patients received antimalarial th erapy. The clinical course of ARF was consistent with acute tubular ne crosis in 20 patients. Six cases were subjected to percutaneous renal biopsy. One patient showed histological features of necrotizing glomer ulonephritis along with acute tubulointerstitial nephritis. The biopsi es in the other five patients showed features of acute tubular necrosi s in three, and acute interstitial oedema with patchy tubular necrosis in two. The mortality rate was 30.8%. Thus falciparum malaria, which has been an important cause of ARF in certain highly endemic zones of India, is showing an increasing prevalence in other parts such as East ern Uttar Pradesh due to an imbalance between the increasing populatio n and inadequate sanitary facilities, which further worsen during floo ds.