Black water fever associated with acute renal failure among congolese children in Kinshasa

• Published in: Saudi journal of kidney diseases and transplantation Vol. 25; no. 6; pp. 1353 - 1358
• Main Authors: Tshibassu, Pierre M., Kunuanuna, Thomas S., Lukute, Guy N., Aloni, Michel N., Nsibu, Celestin N., Pakasa, Nestor M., Bodi, Joseph M.
• Format: Journal Article
• Language: English
• Published: Riyadh, Saudi Arabia Saudi Center for Organ Transplantation 01.11.2014; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer Medknow Publications
• Subjects: Acidosis - parasitology; Acute Kidney Injury - diagnosis; Acute Kidney Injury - mortality; Acute Kidney Injury - parasitology; Acute Kidney Injury - therapy; Acute renal failure; Acute renal failure in children; Adolescent; Age Factors; Biomarkers - blood; Blackwater fever; Blackwater Fever - complications; Blackwater Fever - diagnosis; Blackwater Fever - mortality; Blackwater Fever - parasitology; Blackwater Fever - therapy; Care and treatment; Child; Child, Preschool; Complications and side effects; Creatinine - blood; Democratic Republic of the Congo; Distribution; Female; Health Care Surveys; Hospitals, University; Humans; Male; Peritoneal Dialysis; Prospective Studies; Retrospective Studies; Risk Factors; Treatment Outcome; Urea - blood; الأطفال; الفشل الكلوي; حمى البول الأسود; Democratic Republic of the Congo; Congo (Kinshasa)
• ISSN: 1319-2442; 2320-3838
• DOI: 10.4103/1319-2442.144326

Acute renal failure (ARF) is reported in some severe forms of malaria such as black water fever (BWF). It is associated with a high mortality rate and can be managed effectively with adequate renal replacement. A prospective survey of children with dark urine after a malarial infection with Plasmodium falciparum was coupled with a chart review study of patients managed in the past 11 years in the Pediatrics’ Kinshasa University Hospital. Eighty-nine cases of ARF were identified, but data from only 63 patients were available, of whom 44 (69.8 %) had severe malaria (39 with BWF and 5 with cerebral malaria). The mean age of the patients was 8.2 ± 1.73 years. Of the 39 cases of BWF, an association with quinine ingestion was observed in 32 children (82 %). Urea and creatinine levels were elevated in all cases (135.4 ± 88.2 and 3.83 ± 2.81 mg/dL, respectively). Oligo-anuria was observed in 44.4 %, severe metabolic acidosis (bicarbonate < 15 mEq / L) in 61.5 % and hyponatremia (< 1 30 mEq / L) in 33.3 %. Peritoneal dialysis was required in 36 patients, including 20 with BWF. The remaining patients were managed with conservative treatment. Twenty-eight children (44.4 %), including 20 on dialysis, fully recovered and 14 died (22.2 %), including eight cases of BWF. Our study suggests that ARF is commonly associated with BWF in Congolese children. Elevated urea and creatinine and severe metabolic acidosis were observed more often than other clinical/metabolic disturbances. Severe renal impairment remains a significant complication with a high mortality rate in low-resource settings.