ABSTRACT
Background: While malaria rarely occurs in many parts of the world, it still causes serious complications like acute kidney injury (AKI) in endemic areas and needs to be reported. Methods: This study was carried out at Sindh Institute of Urology and Transplantation, Karachi, Pakistan. From January 1990 – December 2014, 5623 patients with acute kidney injury (AKI) were registered at this institution. AKI was defined as sudden rise in creatinine or decline in urine output or both. All patients had normal sized non obstructed kidneys on ultrasonography, with no previous co morbidity. Malaria parasite was seen on blood peripheral film in all patients. Results: Among total patients with AKI, 671 (11.93%) developed AKI in association with malarial infection. Average age of patients was 33.70±16.426 (range 4-98 years) with M: F ratio of 3:1. The causes were plasmodium falciparum in 59%, vivax in 15.2%, dual infection in 3.57% and undefined species in the rest. Oligo-anuria and vomiting were the most common associated symptoms along with fever. Renal replacement therapy was required in 76.6% of patients. Complete recovery was seen in 64.82%, while 21.2% died during the acute phase of illness. Jaundice, old age, altered level of consciousness, raised total leukocyte count, oliguria, hyperkalemia and falciparum malaria were the independent risk factors associated with high mortality. Conclusion: Malaria still causes significant morbidity and mortality in our part of the world. Vivax malaria which was thought to be ‘benign’ can present with hemolysis, thrombocytopenia and kidney failure, though risk of death is 2.36 fold higher with falciparum malaria.
ABSTRACT
Objectives: We aim to report here a series of cases developing AKI after scorpion stings. Patients and Methods: During a period of 25 years that is; from January 1990- December 2014 all the patients coming to Sindh Institute of Urology and Transplantation, with AKI after scorpion sting are included in study. AKI was defined according to RIFLE criteria and Scorpion sting was labeled on history of person stung by scorpion. Results: During studied period 18 patients were brought with scorpion sting. Mean age of patients was 29.22±18.48 years, 7 were male and 11 females. Mean duration of insult was 8.94±4.12 days. Sixteen out of 18 patients were either oliguric or anuric on presentation. Uremia was advanced on arrival with mean urea of 324.38±116.82 and creatinine of 11.8±4.30 mg/dl. Hyponatremia was a common finding with mean sodium of 129.16±8.76 meq/l. Extensive tissue damage at site of sting observed in many patients and mean values for LDH and CK were 2349.71±3499.15 and 3116.23±5468.22 U/L respectively. Hemodialysis required in all patients. Complete renal recovery seen in 13 patients, 2 expired and 3 discharged from hospital in partial state of recovery and never turned for follow up. Conclusion: Scorpion sting is major health problem in many parts of our country, in majority it takes a benign course but in some may affect multiple organs and result in death, especially if initial treatment is delayed.