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Category: Volume 05 Issue 08 August 2017
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Title: Profile of Acute Kidney Injury in Plasmodium Vivax Malaria

Authors: Dr Ashwini Kumar Nigam, Dr Akhilesh Kumar Singh, Dr Ashish Gautam, Dr Bechan Kumar Gautam

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i8.174

Abstract

Background: Malaria due to plasmodium vivax(P. vivax) increased now days. Acute Kidney Injury (AKI) is one of the serious complications of P. vivax malaria, worsening its prognosis.

Objectives: To describe prevalence, clinical characteristics, mortality predictor, outcome and need of renal replacement therapy in patients of AKI associated with P. vivax malaria.

Materials & Methods: This is the prospective observational study conducted in Sarojini Naidu Medical College, Agra between November 2015 and October 2016. It included all cases presented with fever with evidence of AKI. Diagnosis of malaria was confirmed by thick and thin blood films stained with Leishman’s stain for malaria parasite and P. vivax cases underwent for OPTIMAL malarial antigen test to rule out mixed malarial infection.

Result: AKI occurred in 37 patients (33.03%)out of 112 patients of P. vivax malaria. The clinical feature of P. vivax malaria associated with AKI includes fever (100%), jaundice (62.1%), pallor (56.7%), hypotension (45.94%), hemolysis (51.35%), disseminated intravascular coagulation (DIC) (35.1%), sepsis (29.7%), thrombocytopenia (78..37%), cerebral malaria (2.7%), nausea and vomiting (100%), oliguria (67.56%), acute respiratory distress syndrome(ARDS) (2.7%). All 37 patients with AKI received artesunate. Mortality in P. vivax malaria cases was found 7 (6.25%) out of 112 patients. Out of 7 mortality, 6 patients were suffered from AKI with other complications. Mortality in AKI cases 6 (16.21%), seven patients underwent for hemodialysis. Oliguria on admission, hyperbilirubinemia, hyponatremia, hypotension, metabolic acidosis, DIC, cerebral anaemia and ARDS were main predictor of mortality in our study.

Conclusion: AKI is now common in P. vivax malaria and has significant mortality and morbidity. Its early recognition and management can improve the outcome.

Keywords: Plasmodium vivax, acute kidney injury, dialysis.

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Corresponding Author

Dr Ashwini Kumar Nigam

Associate Professor, Post Graduate Department of Medicine,

Sarojini Naidu Medical College, Agra