Acute Renal Failure in Severe Malaria in West Africa: A Retrospective Study Conducted between 2011 and 2014 at Aristide Le Dantec Hospital in Dakar, Senegal

Abstract

Introduction: Acute renal failure (ARF) is one of the most daunting complications in severe malaria. The features of ARF in malaria are not well-known in Senegal. Our purpose when carrying out this study was to describe the epidemiological, clinical, Para clinical, treatment and outcome of those manifestations. Patients and Methods: This was a descriptive retrospective study over a 3 year period, from 1 January 2011 to 31 December 2014. The people involved were patients with acute kidney failure during malaria. ARF in malaria was defined as urine output of less than 400 ml/24 hour or creatinine level greater than 13 mg/l (adults), diuresis of less than 12 mL/kg/24 hour or higher creatinine level with respect to the age (children). The data collected were analyzed using SPSS software. Results: During the study period, we selected records of 11 patients, including 5 children and 6 adults. The average age of children was 12 ± 2.34 years; it was 30.83 ± 15.34 years for adults. The sex ratio was 1.75. Eight patients had vomiting. Fever was observed in 10 patients. Impaired consciousness was present in 5 patients. Anuria was noted in 3 patients; 6 patients had edema syndrome. Urea average rate was 3.72 ± 1.43 g/L, and the mean value of creatinine level was 149.96 ± 39 mg/L. There was positive thick blood in 6 out of 7 patients, and the mean parasite density was 18,106.5 ± 14,228.5 parasites per μl. The mean hemoglobin level was 6.09 ± 1.71 g/dl. Thrombocytopenia was present in 6 patients (54.5%). The kidneys were well-differentiated in 4 patients. Acute tubular necrosis was diagnosed in 7 patients (63.6%). Quinine was administered in 9 patients. Hemodialysis was performed in nine patients. The outcome was favorable in 5 patients (2 adults and 3 children), 2 children died. Conclusion: This study has allowed us to notice serious cases of ARF in severe malaria, especially in children. This was diagnosed too late most of the time. Senegal must implement all human and technical resources to detect ARF in malaria as early as possible. Access to renal replacement therapy should also be facilitated.