Acute renal failure during severe malaria in children in the nephrology unit of the Fousseyni DAOU hospital in Kayes, Mali

Abstract

Introduction: The management of acute renal failure in severe malaria remains a real challenge in a context characterized by scarce financial resources and poor technical facilities. The aim of this study was to determine the diagnostic, therapeutic and evolutionary aspects of renal failure in this field. Materials and methods: this was a prospective, descriptive study carried out in the pediatrics department and nephrology unit of Kayes Hospital from July 1 to November 30, 2022. All children with impaired renal function, positive thick drop and/or Rapid Diagnostic Test (RDT) were included. Results: We enrolled 11 patients, 6 boys and 5 girls, with a sex ratio of 1.2. The median age was 9.09 years, with extremes of 7 and 14 years. In all patients, referral to a nephrologist was prompted by elevated creatinine levels, with a mean value of 917.09 ± 424.54 µmol/l. Clinical signs included vomiting in 11 cases (100%), conjunctivo-palmar pallor in 11 cases (100%), dyspnea in 8 cases (72.7%). The mean hemoglobin level was 7.45 g/dl. Parasite density ranged from 171 to 1441 trophozoites/µl in 7 patients. Artemeter therapy was combined with temporary hemodialysis in 8 (72.7%) patients. Progression was favorable in 9 (81.82%). We recorded 2 cases of death in the context of haemorrhagic syndrome. Conclusion: Acute renal failure in severe malaria presents several clinical pictures of varying severity.