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Query: UMLS:C0024530 (malaria)
 44,886 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Malaria is widely prevalent in the tropics. Clinically significant renal and renal-related disorders commonly occur in infection with Plasmodium falciparum and P. malariae. Falciparum malaria causes fluid and electrolyte disorders, transient and mild glomerulonephritis, and acute renal failure (ARF). It appears that ARF is mediated by a complex interaction of mechanical, immunologic, cytokine, humoral, acute phase response, nonspecific factors, and hemodynamic factors. Parasitized erythrocytes play a central role in all aforementioned pathogenic factors of ARF. Antimalarial drugs are still the cornerstone of treatment of falciparum infection. Because of the hypercatabolic state of falciparum malaria-induced ARF, hemodialysis as well as peritoneal dialysis should be immediately performed when there is a rapid increase of creatinine concentration. P. malariae, in contradistinction, can cause chronic glomerulopathy that may relentlessly progress to end-stage renal disease. Antimalarial drugs, corticosteroids, and immunosuppressive agents are not effective.
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PMID:Malarial nephropathy. 1256 98

Renal diseases unique to the tropics are those that occur in association with infectious diseases including dengue hemorrhagic fever, typhoid fever, shigellosis, leptospirosis, lepromatous leprosy, malaria, opisthorchiasis, and schistosomiasis. These renal complications can be classified on the basis of their clinical and pathologic characteristics into acute transient reversible glomerulonephritis, chronic progressive irreversible glomerulonephritis, amyloidosis, and acute renal failure (ARF) resulting from acute tubular necrosis, acute tubulointerstitial nephritis, and thrombotic microangiopathy. Certain primary glomerular diseases including immunoglobulin (Ig) M nephropathy and focal segmental and global glomerulosclerosis are prevalent in some tropical countries. Renal complications of venomous snakebites also are common in the tropics. This article discusses and summarizes important works in the literature in respect to the clinical syndromes, pathologic features, and pathogenesis of tropical renal diseases both in humans and experimental animal models.
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PMID:Pathology of renal diseases in the tropics. 1256 4

The major health problems in Africa are AIDS, tuberculosis, malaria, gastroenteritis and hypertension; hypertension affects about 20% of the adult population. Renal disease, especially glomerular disease, is more prevalent in Africa and seems to be of a more severe form than that found in Western countries. The most common mode of presentation is the nephrotic syndrome, with the age of onset at five to eight years. It is estimated that 2 to 3% of medical admissions in tropical countries are due to renal-related complaints, the majority being the glomerulonephritides. There are no reliable statistics for ESRD in all African countries. Statistics of the South African Dialysis and Transplant Registry (SADTR) reflect the patients selected for renal replacement therapy (RRT) and do not accurately reflect the etiology of chronic renal failure (CRF), where public sector state facilities will offer RRT only to patients who are eligible for a transplant. In 1994, glomerulonephritis was recorded as the cause of ESRD in 1771 (52.1%) and hypertension in 1549 (45.6%) of patients by the SADTR. In a six-year study of 3632 patients with ESRD, based on SADTR statistics, hypertension was reported to be the cause of ESRD in 4.3% of whites, 34.6% of blacks, 20.9% mixed race group and 13.8% of Indians. Malignant hypertension is an important cause of morbidity and mortality among urban black South Africans, with hypertension accounting for 16% of all hospital admissions. In a ten-year study of 368 patients with chronic renal failure in Nigeria, the etiology of renal failure was undetermined in 62%. Of the remaining patients whose etiology was ascertained, hypertension accounted for 61%, diabetes mellitus for 11% and chronic glomerulonephritis for 5.9%. Patients with CRF constituted 10% of all medical admissions in this center. Chronic glomerulonephritis and hypertension are principal causes of CRF in tropical Africa and East Africa, together with diabetes mellitus and obstructive uropathy. The availability of dialysis and transplantation is quite variable in Africa: treatment rates in North Africa are 30 to 186.5 per million population (pmp) in countries with more established programs: Algeria 78.5; Egypt 129.3; Libya 30; Morocco 55.6; Tunisia 186.5 pmp. In South Africa, treatment rates of 99 pmp were reported; Dialysis and transplant programs in the rest of Africa are dependent on the availability of funding and donors. Services are still predominantly urban and therefore generally inaccessible to the poorer, less educated rural patient. There is not enough money for healthcare in the developing world, particularly for expensive and chronic treatment such as RRT. The goal should be to have a circumscribed chronic dialysis program, with as short a time on dialysis as possible, and to increase the availability of transplantation (both living donor and cadaver). Efforts should be made to optimize therapy of renal disease and renal failure globally and particularly in developing countries. Strategies should be developed to screen for and manage conditions such as hypertension and diabetes mellitus at the primary healthcare level in an effort to decrease the incidence of chronic renal failure. Increasingly, health is influenced by social and economic circumstances. Any improvements in health thus demand integrated, comprehensive action against all the determinants of ill health.
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PMID:End-stage renal disease in sub-Saharan and South Africa. 1286 89

Erythropoietin is a growth factor for endothelial cells as well as for erythroid cells. In contrast to their proliferative response to physiological levels of erythropoietin, endothelial cells may respond to decreased levels by triggering a process called neocytolysis. Neocytolysis is the selective destruction of the youngest circulating red cells, which may be prompted by endothelial cells communicating with macrophages to stimulate phagocytosis of this unusual cell subset. We speculate that this is due to decreased production by endothelial cells of the macrophage-deactivating transforming growth factor-beta. The resulting proinflammatory phenotype may include macrophage production of thrombospondin, which forms bridges between adhesion molecules selectively expressed on young red cells (CD36) and the CD36/alphavbeta3 complex on macrophages that triggers phagocytosis. Alternatively, inflammatory mediators secreted by endothelial cells and macrophages during erythropoietin withdrawal may signal young red cells to expose phosphatidylserine, which would mark them for elimination via the normal pathway for aged red cell destruction. Neocytolysis has been demonstrated in returning astronauts and in polycythemic individuals at high altitude on descent to sea level. It contributes to the anemia of renal disease, is triggered by the rapidly falling levels of erythropoietin seen after intravenous administration, and may be the normal mechanism for reduction of red cell mass in newborns. It may play a role in chronic diseases including malaria and sickle cell anemia. New erythropoietin products and methods of administration avoid the intermittent rapid decreases associated with the stimulus for neocytolysis, but study of this phenomenon may yield further improvements in drug design.
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PMID:Erythropoietin withdrawal leads to the destruction of young red cells at the endothelial-macrophage interface. 1475 97

Hospitalized patients with HIV infection are among the most likely to benefit from the expanding availability of anti-retroviral therapy in sub-Saharan Africa. Between 1990 and 2000, 3667 people known to be HIV-infected were admitted to Kilimanjaro Christian Medical Centre (KCMC) in Moshi, northen Tanzania. The level of inpatient mortality among these patients varied from 15%-21%, and the proportion of the HIV-infected patients admitted who were female increased significantly, from 45% at the start of the study period to 52% at the end (P <0.001). When the medical records for 1683 of the HIV-infected patients who had been admitted between 1996 and 2001 were reviewed, the most prevalent diagnoses on admission were found to be pulmonary tuberculosis (21%), malaria (14%) and gastro-enteritis/diarrhoea (12%) among the adults, and non-tubercular pulmonary infection (21%), pulmonary tuberculosis (19%) and gastro-enteritis/diarrhoea (12%) among the children. The crude odds ratios (OR) for inpatient death were greatest for adults presenting with meningitis [OR=3.7; 95% confidence interval (CI)=2.1-6.7], septicaemia (OR=2.9; CI=1.2-7.3) or renal disease (OR=2.6; CI=1.2-5.7), and mortality was higher for men than for women (OR=1.4; CI=1.1-1.8). A single-day, point-prevalence survey in September 2001, among the KCMC's inpatients, identified HIV infection in 21% of those surveyed, many (44%) of the patients found positive being previously unaware of their infection. HIV infection remains a major cause of hospitalization and mortality in Moshi. A policy of routine testing would increase the number of HIV infections detected, allowing improvements in case management and in the prevention of infection.
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PMID:HIV-associated morbidity, mortality and diagnostic testing opportunities among inpatients at a referral hospital in northern Tanzania. 1503 27

Renal damage in malaria occurs as a result of two distinct mechanisms: microcirculatory disturbance, which is confined to falciparum malaria, and immunological damage through the deposition of soluble immune complexes. Quartan malarial nephropathy, due to Plasmodium malariae, is a progressive disease ending in chronic, hypertensive, renal failure. The disease seems most prevalent in adolescents, placing a heavy burden on the health services of developing countries where falciparum malaria is endemic.
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PMID:The hazard of malarial nephropathy. 1546 93

Between January 2000 and December 2001, renal involvement in 81 cases of malaria was studied. Their age ranged between 05 and 66 (mean 35.5) years. Distribution of malarial parasite was P falciparum (75), mixed infection (4) and P vivax (2). The evidence of clinical renal disease in the form of acute renal failure, electrolyte abnormality, abnormal urinary sediment and increased urinary protein excretion (>500 mg/24 hours) was found in 100%, 91.3%, 46.9% and 18.5% respectively. Probable aetiopathogenesis of acute renal failure (ARF) was multifactorial. Volume depletion (72.8%) was the dominant cause of ARF in these patients. In addition, hyperbilirubinaemia, intravascular haemolysis and sepsis were responsible for ARF in 64.2%, 70.3% and 25.9% cases respectively. All the patients were managed with anti-malarial drugs and dialysis support was needed in 35 patients (43.2%). Prognosis of malarial acute renal failure is favourable with mortality rate of 18.5%. Multi-organ failure was the commonest cause (33.3%) of death.
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PMID:Spectrum of renal disease in malaria. 1547 74

Malaria remains one of the world's major health problems, particularly in developing tropical countries. Imported malaria is reportedly increasing in Western countries. Acute renal failure (ARF) is the most common cause of death in severe malaria. We report the case of a 63-year-old female patient with a history of travel to a rural area in South Africa who was in coma and had a high fever on admission. Thirty percent of her erythrocytes were infected with Plasmodium falciparum. She had cerebral malaria, malarial nephropathy, anemia, hepatic dysfunction, and disseminated intravenous coagulation (DIC). Quinine and artesunate treatment decreased the number of parasites in the blood. To manage renal failure, hemodialysis was performed for 11 days. A relationship between ARF and hepatic dysfunction was suggested. This relationship is an indication of the clinical course of the disease. In this article, we discuss the mechanism underlying the development of malarial nephropathy and its management, particularly the usefulness of hemodialysis.
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PMID:A female patient with malarial nephropathy. 1561 37

Glomerular disease is common in tropical regions and may complicate many locally prevalent infections by a variety of mechanisms. In areas where HIV and malaria are common, these may be factors predisposing to renal disease. Primary glomerulonephritis also occurs in these regions, and the nature of the renal lesion can only reliably be determined if renal biopsy and expert histologic analysis are available. Assistance to the developing world in provision of these skills and resources is a major priority for the International Society of Nephrology. This article highlights some general principles regarding glomerular disease in the developing world, illustrated by the author's experience in rural Uganda.
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PMID:Glomerulonephritis in the tropics: who are the culprits? 1677 11

Congestive cardiac failure (CCF) is a common paediatric emergency with diverse aetiologies. The objective of this study is to define the current prevalence rate and common causes of CCF among children hospitalized in a Nigerian Tertiary Hospital. The study was prospectively done over a 1-year period in the Paediatric Wards of the hospital. Consecutive children aged 0-14 years, who fulfilled the standard diagnostic criteria for CCF were recruited. Data obtained from them included the age, sex, duration of illness and the socioeconomic status of the parents. Each subject was given a specific diagnosis based on the clinical, laboratory and radiological features. Out of a total of 1552 admissions, 109 had CCF giving the prevalence of 7.02%. The mean age of children with CCF was mean of 2 +/- 3.1 years (range: 1 day to 14 years). Ninety-five (91%) of them were concentrated in the lower socioeconomic classes III-V. The aetiologies of CCF identified in this study were as follows: severe anaemia occurring alone (48; 46%), lower respiratory tract infections (LRTI) (30; 29%), anaemia with LRTI (12; 11.5%), congenital heart diseases (CHD) (11; 10.5%), rheumatic heart disease (1; 1%), myocarditis (1; 1%) and chronic renal disease (1; 1%). Malaria was the commonest cause of anaemia while bronchopneumonia was the commonest form of LRTI in the subjects. Measles infection was associated with LRTI in 10 (23.8%) children. Three children had HIV-related anaemia. Infants formed the bulk of the subjects with CCF due to anaemia, LRTI and CHD. Ventricular septal defect was the commonest CHD identified. The prevalence obtained from this study was higher than rates obtained from some previous studies in the country. Severe anaemia is the commonest cause of CCF probably from the effects of severe malaria and increasing poverty. Stringent attention to poverty alleviation and malaria control may reduce the burden of CCF among Nigerian children.
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PMID:Current trends in the prevalence and aetiology of childhood congestive cardiac failure in Sagamu. 1716 31


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