Prognosis of malaria associated severe acute renal failure in children

Between January and December 1996, we observed 64 children (mean age 8.3 years range 4.2 to 11.2 years) who required dialysis for severe acute renal failure secondary to Falciparum Malaria. All received anti malaria therapy and other supportive therapy as well as peritoneal dialysis. Out of these 28 died (43.8%). The children who died (Group I) compared to those who survived (Group II) differed significantly in age (mean +/- SD) (7.2 +/- 1.3 years vs. 9.2 +/- 2.1 years P < 0.05), plasma creatinine at presentation (645 +/- 104 mu mol/L vs. 438 +/- 87 mu mol/L P < 0.05), plasma bilirubin (2.1 +/- 0.3 mg/dL vs. 1.2 +/- 0.2 mg/dL P > 0.02) systolic BP (50 +/- 11 mmHg vs. 90 +/- 12 mmHg P0 < 0.01), diastolic BP (20 +/- 4 mmHg vs. 60 +/- 9 mmHg P < .01) Hb level (5.3 +/- 0.4 g/dL vs. 8 +/- 1.3 gm/dL P < .02), time from diagnosis to referral (5.3 +/- 1.3 days vs. 8.9 +/- 2.1 days P < .05) and urine output (200 +/- 49 mL/24 h vs. 600 mL +/- 131 mL P < .01). There was no significant difference in gender, alanine transaminase (ALT) level, degree of fever, plasma Na or plasma K. Diarrhea was present in 29% of the children who died and in only 11% of those who survived (P > 0.05) and splenomegaly was found in 3% and 18% respectively (PO > .05).