CLINICAL OUTCOMES OF THE MOST SEVERE FORMS OF ACUTE RENAL FAILURE DURING MALARIA UNDER LIMITED CONDITIONS

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https://storage.unitedwebnetwork.com/files/1099/1b69d93bfc92ef43fe39200d3a0f7c6e.pdf

Abstract Title

First Name *

Dejan

Last Name *

Pilčević

Co-author 1

Veljko Milić dejan.pilcevic@gmail.com Military Hospital Niš Department of cardioogy Niš

Co-author 2

Vesna Đenić dejan.pilcevic@gmail.com Military hospital Niš Department of infective diseases Niš

Co-author 3

Boban Krstić dejan.pilcevic@gmail.com Military medical academy Belgrade Clinic for radiology Belgrade

Co-author 4

Darko Selaković dejan.pilcevic@gmail.com Military medical center, Novi Sad Department for surgery Novi Sad

Co-author 5

Violeta Rabrenović dejan.pilcevic@gmail.com Military medical academy, Belgrade Clinic for nephrology Belgrade

Co-author 6

Milica Petrović dejan.pilcevic@gmail.com Military medical academy, Belgrade Clinic for nephrology Belgrade

Co-author 7

Marijana Petrović dejan.pilcevic@gmail.com Military medical academy, Belgrade Clinic for nephrology Belgrade

Co-author 8

Neven Vavić dejan.pilcevic@gmail.com Military medical academy, Belgrade Clinic for nephrology Belgrade

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Aim of our paper is to explore clinical features and outcome of the most severe forms of acute renal failure (ARF) during Plasmodium falciparum malaria in United Nations personnel during the "MINUSCA" peacekeeping mission.

Methods

Retrospective analysis medical records of 54 patients with complicated form of Plasmodium falciparum malaria who were treated in the Serbian's level 2 hospital stationed in the Central African Republic. Diagnosis of ARF was estimated based on RIFLE criteria. Having in mind the occasional lack of diagnostic kits for creatinine, in almost one third of patients we used daily diuresis monitoring (with follow-up of volume status) to diagnose this complication (according to RIFLE criteria).

Results

All patients were treated with Artemisin medicaments, intensive parenteral rehidratations and diuretics. A total of 19 patients (35,19%) developed ARF. Despite applied therapy, 8 patients (14,81%) developed progressive and dialysis dependent form of ARF (one had hemolytic-uremic syndrome) and they were urgently evacuated to a senior medical institution. 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 chronic renal failure grade 3 and one developed end stage renal disease with necessity for chronic dialysis treatment. There were no death outcomes.

Conclusions

Early recognition of systemic complications of malaria including parameters of acute renal failure (decreasing urine output or changing of urine color could be useful markers under limited medical conditions) is fundamental for the prompt evacuation into higher medical facilities for proper further treatment this severe disease

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