Naqvi et al identified risk factors associated with mortality in patients with acute renal failure associated with malaria. These can help to identify a patient who may benefit from more aggressive management. The authors are from Dow Medical College and Civil Hospital in Karachi, Pakistan.
Outcome: death, with 25% of patients dying within 48 hours of admission
Criteria for malarial renal failure: serum creatinine > 2 mg/dL with malaria and with other possible causes excluded
Risk factors for mortality in multivariate analysis:
(1) disseminated intravascular coagulopathy (DIC)
(2) central nervous system (CNS) involvement
Additional risk factors:
(1) oliguria or anuria
(2) older age (mean age for mortality was 41 (+/- 21) years vs 31 (+/-15) for survivors)
(3) delay in diagnosis and appropriate therapy
Institution of dialysis and antimalarial therapy are important for recovery of renal function in patients who survive the early peak in mortality.
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