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Malaria is characterized by intermittent fever with chill and rigor; and hepatosplenomegaly. The involvement of the kidney in falciparum malaria has been known for decades. The initial clinical pattern is that of reversible renal dysfunction or pre-renal azotemia, which rapidly progresses to acute tubular necrosis if treatment is not started. Material and methods: Fifty cases of acute renal failure selected from amongst 174 diagnosed cases of falciparum malaria admitted in R.G.Kar Medical College & Hospital were studied (cross sectional study). The cases of acute renal failure were diagnosed on the basis of serum creatinine concentration > 3mg/dl (>265μmol/L) and/or 24-hour urine output < 400 ml, despite adequate rehydration, occurring within a few hours to days during the course of the malarial fever. Cases were followed up in the hospital with respect to management and prognosis. Results: Out of the total of 174 cases of falciparum malaria only 50 cases (28.7%) had clinical and biochemical features of renal failure. Analysis of the patients with acute renal failure revealed that pre-renal azotemia secondary to volume depletion or hyper catabolism was present in 14 cases (28%), and in 36 patients (72%), the cause of acute renal failure was acute tubular necrosis. Haemodialysis was done in the total 62% cases. Among 31 patients requiring the haemodialysis 24 (86%) were oliguric and 07(14%) non-oliguric. Conclusion: Cases of pre-renal azotaemia respond well to Antimalarial therapy and conservative treatment with excellent prognosis. Early and frequent Haemodialysis helps in reducing mortality in most of the cases of acute tubular necrosis.

A Study on Acute Renal Failure in Falciparum Malaria with Special Reference to its Clinical Manifestations, Biochemical Parameters and Management