DIAGNOSTIC AND TREATMENT OF THE SEVERE FORMS OF ACUTE RENAL FAILURE DURING MALARIA UNDER LIMITED CONDITIONS

Abstract Background and Aims To explore clinical features and outcome of the most severe forms of acute renal failure (ARF) during Plasmodium falciparum malaria in United Nations personnel stationed in Central African Republic, during “MINUSCA ” mission. ARF is one of the most important negative predictive criteria for outcome of malaria.Etiology is multifactorial, but most often is consequence of prerenal dehydration and tubular damages with hemoglobinuria during severe hemolysis Method We analyzed records of 54 inpatients with complicated forms of Plasmodium falciparum malaria who were treated in the Serbian level 2 hospital during 2017. Diagnosis of ARF was estimated based on RIFLE criteria. Having in mind the occasional lack of diagnostic kits for creatinine, at the almost one third of patients we used daily diuresis monitoring (with follow up of volume status) to diagnose this complication (according with RIFLE criteria). Results Total of 19 patients (35,19%) have developed ARF. Beside parenteral treatment with Artemisin, they were treated with parenteral solutions and diuretics. Despite therapy, 8 patients (14,81%) developed progressive and dialysis depended form of ARF (one had hemolytic-uremic syndrome) and they have been urgently evacuated accompanied by AMET into a senior medical institution. Based on provided back information, average creatinine on admission was 1242+/-342 µmol/l, Hb level 10,6 g/dl, potassium 6,8mmol/l. Six out of 8 patients completely recovered renal function (they needed average 7+/- 2 HD procedures; patient with HUS performed 5 plasma exchange sessions), one developed CRF grade 3 and one developed ESRD with necessity for chronic HD treatment. There were not lethal outcomes. Conclusion Early recognition of systemic complications including parameters of acute renal failure (decreasing urine output or changing of urine color could be useful markers under limited medical conditions)is necessaryin the purpose of timely recognition and promptly evacuation into higher medical facilities for further treatment.