36721 - ACUTE RENAL FAILURE IN SEVERE MALARIA Dr Saroj K...

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Unformatted text preview: ACUTE RENAL FAILURE IN SEVERE MALARIA Dr Saroj K Mishra Dr Kishore C Mahanta Ispat General Hospital, Rourkela Orissa India INTRODUCTION Malaria is one of top 10 killer diseases in world ARF occurs in <1% of pf malaria, but mortality up to 45% Common in adults than children, recent trends- high incidence Diagnosed when sr. creat.>3mg/dl or urine output <400ml/24 hrs Renal involvement varies from mild proteinuria to severe azotemia Malarial ARF is associated with CM, Jaundice, Anaemia, ARDS/Pulm. edema & Hypoglycaemia INTRODUCTION Contd. Two different settings- a) ARF as a component of MOF present at the time of admission, Often associated with poor prognosis. b) Present as a sole complication at a later stage of the course, when other complications subsided or treated, Often associated with recovery. Pathology & Pathogenesis In mild cases- not much change in renal parenchyma- may be minimal tubular degeneration, mild renal parenchymal change & presence of vacuoles In severe cases- Tubular degeneration with distal tubular necrosis, Proximal tubules are often loaded with malarial pigments, Hb granules may be seen in the tubular cells Pathology & Pathogenesis 2 Most patients have little or no proteinuria & urinary sediment contains occasional granular and hyaline cast but no RBC. Absence of hypertension, Rapid resolution without residual impairment & predominant in adults rather than children with urinary findings suggests- ARF results from ATN & not glomerulonephritis Pathology & Pathogenesis 3 ARF- mediated thro several mechanisms 1.Effect of pRBC on microcirculation- knob like processes formation on surface of RBC which helps in anchoring the endothelium...
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This note was uploaded on 02/22/2012 for the course HIST 312 taught by Professor Staff during the Fall '10 term at Rutgers.

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36721 - ACUTE RENAL FAILURE IN SEVERE MALARIA Dr Saroj K...

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