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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.
RESUMO
<p><b>OBJECTIVE</b>Embryonic movements (EM) and angiogenesis pathways are evolutionarily conserved mechanisms which are essential for proper embryonic development. Deviations in these processes by exposure to cigarette smoke condensate (CSC) may cause vascular and morphogenetic disorders.</p><p><b>METHODS</b>Using chicken and mouse embryos, we have demonstrated the in vivo effects of CSC on EM, vascular development, and organogenesis.</p><p><b>RESULTS</b>Examination of the CSC exposed chicken embryos revealed a significant reduction in EM, stunted growth, deviated pattern of blood vessels, hemorrhages, and localized necrosis. Likewise, mouse embryos that were exposed to CSC at E8.5 and E9.5 died between E11.5 and E12.5, respectively. These mouse embryos showed defects in morphogenesis and remodeling of the embryonic vasculature, while littermate controls showed normal development.</p><p><b>CONCLUSIONS</b>Cigarette smoking during pregnancy is fatal for growing embryos. CSC may induce the remodeling of embryonic vasculature, leading to various pathologies.</p>