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Renal impairment in falciparum malaria leads to poor prognosis. Serum creatinine is the mainstay of diagnosis. However, the serum creatinine concentration is only observed when the glomerular filtration rate falls below 50%. We evaluated the use of the urine dipstick method to predict renal impairment in 77 patients. Twenty-three (29.8%) had haematuria and 52 (67.5%) had urinary protein > or = 300 mg/L. Renal impairment (plasma creatinine > or = 1.2 mg/dL) was observed in 17 patients. The sensitivity and specificity of haematuria in the detection of renal impairment was 94.1% and 90.8%, but for proteinuria it was 88.2% and 62.7%, respectively. There was a positive correlation of plasma urea and creatinine with haematuria (r = 0.56, P < 0.001; r = 0.46, P < 0.01) but not with proteinuria. The detection of haematuria using a dipstick seems to be a highly specific and sensitive method of observing renal impairment in malaria. This is probably the first study which utilizes a commonly available tool that can be easily adopted for early recognition in rural areas.

There are very few reports in the literature of rhabdomyolysis in falciparum malaria and they mostly consist of single case studies. A report from Sri Lanka described a single patient with myoglobinuria and skeletal muscle necrosis. Taylor and Prosser reported a single case of rhabdomyolysis with renal failure. We report on 12 patients with evidence of skeletal muscle injury in severe malaria from Rourkela, Orissa State, India.

We analysed 110 adult patients with cerebral malaria, 38 of whom had serum creatinine above 3 mg%, to study the effect of acute renal failure (ARF) on survival. Patients with cerebral malaria had an increased risk of death (39.5% versus 13.9%) when also suffering from ARF. For each one log unit increase of creatinine at admission, odds of death increased by a factor of 10.8 (95% confidence interval 3.0-39.4).