Malarial nephropathy is an important but rare complication of malarial infection. Generally, renal ischemia in malaria can be induced by a combination of several pathophysiological changes and these changes include hypovolemia, hyperviscosity, and catecholamine release.Citation[1] In addition, renal ischemia may be of great enough degree to cause renal failure.Citation[1] Acute renal failure (ARF) can be observed in malarial patients who had heavy infestation of Plasmodium falciparum and this is associated with low urine sodium, a retained ability of tubular reabsorption of water and the nonremarkable urine findings from urinalysis. Falciparum malaria–induced ARF is mediated by a complex interaction of mechanical, immunologic, cytokine, humoral, acute phase response, nonspecific factors, and hemodynamic factors. Eiam-ong said that because of the hypercatabolic state of falciparum malaria–induced ARF, dialysis should be immediately performed when there is a rapid increase of creatinine concentration.Citation[2]
Here, the author performs this mini-study in order to summarize the outcomes of peritoneal dialysis (PD) among reported Thai cases of falciparum malaria–induced ARF. A literature review on the papers concerning PD among Thai patients with falciparum malaria–induced ARF was performed from the database of the published works cited in the Index Medicus and Science Citation Index and also the published works in all 256 local Thai journals, which are not included in the international citation index. The reports that contained incomplete data were excluded from further analysis.
According to this review, there were four reportsCitation[2-6] covering 46 Thai patients (age range = 13–57 years) who had PD according to falciparum malaria–induced ARF. Concerning the PD procedure, a Tenckhoff catheter was inserted and 1.5 L/hour dialysate exchange performed during the initial 48 hours for removal of accumulated uremic toxin and the exchange was then decreased to every 4 hours. All patients also received standard antimalarial therapy accompanied by PD. Of the 46 patients, 11 died (23.9%). There was an association between the day of illness when PD was started and mortality rates. The average duration of symptoms before admission to a dialysis unit among survivors and nonsurvivors was 5.6 days and 8.6 days, respectively. These observations suggest that PD is beneficial in treating ARF associated with severe malaria, especially when instituted earlier in the course of illness.
References
- Sitprija, V.; Vongsthongsri, M.; Poshyachinda, V.; Arthachinta, S. Pathogenesis of renal failure in malaria. J. Med. Assoc. Thail. 1978, 61 (Suppl. 1), 71–73. [CSA]
- Eiam-ong, S. Malarial nephropathy. Semin. Nephrol. 2003, 23, 21–33. [PUBMED], [INFOTRIEVE], [CSA], [CROSSREF]
- Thepsamarn, A P. The use of peritoneal dialysis in acute renal failure during severe malaria: a survey at Tak Provincial Hospital. J. Infect. Dis. Antimicrob. Agents 1997, 14, 5–9. [CSA]
- Thepsamarn, P. Peritoneal dialysis in acute renal failure from falciparum malaria in King Taksin Maharaj Hospital Title. Reg. 6 Med. J. 1993, 6, 23–32. [CSA]
- Indraprasit, S.; Mavichak, V.; Tantitham, J.; Charoenpan, P. Continuous peritoneal dialysis in acute renal failure (ARF) from complicated falciparum malaria. Bull. Nephrol. Soc. Thail. 1986, 6, 34. [CSA]
- Indraprasit, S.; Charoepan, P.; Suvachittanont, O.; Mavichak, V.; Kiatboonsri, S.; Tanomsup, S. Continuous peritoneal dialysis (CPD) in management of renal and respiratory failure from severe falciparum malaria (FM). Bull. Nephrol. Soc. Thail. 1986, 6, 14–15. [CSA]