The artificial kidney in malaria and blackwater fever

Abstract

Of four patients (one civilian and three Service men) who developed acute renal failure complicating P. falciparum malaria and blackwater fever, two had severe cerebral malaria from which one recovered. Of the remaining two, one died during air transit a few hours before admission and the other patient survived. Haemodialysis was performed on three of the patients. One patient, a civil airline pilot, became ill in the United Kingdom ; the other three were evacuated by air from Bahrein, Aden, and West Africa via Las Palmas. The dangers of inadequate malaria prophylaxis and delay in starting treatment in malaria are stressed. Tubular necrosis is confirmed by renal biopsy and necropsy as the lesion causing the renal failure which follows severe P. falciparum malaria and blackwater fever. Attention is drawn to its reversibility and to the importance of its early recognition. The concept that patients with blackwater fever should not be moved must be revised if those with renal failure are to have every chance of survival. If acute renal failure is present for three days arrangements should be made for transfer to a centre with facilities for haemodialysis. The possibility of patients with malaria developing acute renal failure in the United Kingdom or temperate climates should be borne in mind. It is probable that this is the first record of patients with malarial renal failure being managed with the aid of an artificial kidney. © 1962, British Medical Journal Publishing Group. All rights reserved.