Can urine dipstick tests detect renal impairment in Plasmodium falciparum malaria in a rural setup?

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.