• Vol. 28 No. 4, 578–582
  • 15 July 1999

A Case Series of Falciparum Malaria-induced Acute Renal Failure



Download PDF


Falciparum malaria is a disease of tropical climates which affects 270 million people annually and has an overall mortality of 1%. While the incidence of acute renal failure in malaria is less than 1%, mortality is reported to be as high as 45% in those with renal failure. We report the clinical course and outcome in 5 patients with falciparum malaria-induced acute renal failure treated at the Singapore General Hospital between June and July 1997. All 5 males, with mean age of 35.2 ± 13.1 years, were admitted with history of fever and reported travel to a known malarious zone. Mean laboratory parameters upon admission included serum creatinine 725 ± 515 µmol/L and serum urea 47 ± 31 mmol/L. Three patients with hypotension on admission were started on haemodiafiltration, of whom 2 were subsequently converted to haemodialysis as their haemodynamics improved. Two remaining patients were started on intermittent bicarbonate haemodialysis. The overall mortality in our series was 20%, with 1 patient having died of complications of adult respiratory distress syndrome, disseminated intravascular coagulation and multiorgan failure. The remaining 4 survived and recovered their renal function. The single patient mortality occurred in the patient with admission serum creatinine of 1632 µmol/L, a value significantly higher than that of the 4 patients who survived (mean serum creatinine, 499 ± 106 µmol/L, P <0.002). These results suggest that falciparum malaria associated with acute renal failure is associated with a high morbidity, but early presentation and intervention with appropriate antimalarial and renal replacement therapy is associated with improved survival and recovery of renal function.

Predominantly a disease of hot and humid climates, malaria affects 270 million people worldwide annually, and has a mortality rate of 1%. The increasing morbidity and mortality attributable to malaria in recent years follows the loss, in the early 1970s, of the impetus and impact of the initial WHO eradication programme.

This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.