Login   OR  Register

Iframe embed code :

Presentation url :


Description :

Available ACUTE RENAL FAILURE IN SEVERE MALARIA powerpoint presentation for free download which is uploaded by steve an active user in belonging ppt presentation Health & Wellness category.

Tags :

malaria | malaria disease | malaria treatment

Home / Health & Wellness / Health & Wellness Presentations / ACUTE RENAL FAILURE IN SEVERE MALARIA PowerPoint Presentation


Ppt Presentation Embed Code   Zoom Ppt Presentation

PowerPoint is the world's most popular presentation software which can let you create professional ACUTE RENAL FAILURE IN SEVERE MALARIA powerpoint presentation easily and in no time. This helps you give your presentation on ACUTE RENAL FAILURE IN SEVERE MALARIA in a conference, a school lecture, a business proposal, in a webinar and business and professional representations.

The uploader spent his/her valuable time to create this ACUTE RENAL FAILURE IN SEVERE MALARIA powerpoint presentation slides, to share his/her useful content with the world. This ppt presentation uploaded by worldwideweb in Health & Wellness ppt presentation category is available for free download,and can be used according to your industries like finance, marketing, education, health and many more.

About This Presentation

Slide 1 - ACUTE RENAL FAILURE IN SEVERE MALARIA Dr Saroj K Mishra Dr Kishore C Mahanta Ispat General Hospital, Rourkela Orissa India
Slide 2 - INTRODUCTION Malaria is one of top 10 killer diseases in world ARF occurs in <1% of pf malaria, but mortality up to 45% Common in adults than children, recent trends- high incidence Diagnosed when sr. creat.>3mg/dl or urine output <400ml/24 hrs Renal involvement varies from mild proteinuria to severe azotemia Malarial ARF is associated with CM, Jaundice, Anaemia, ARDS/Pulm. edema & Hypoglycaemia
Slide 3 - INTRODUCTION Contd. Two different settings- ARF as a component of MOF – present at the time of admission, Often associated with poor prognosis. b) Present as a sole complication at a later stage of the course, when other complications subsided or treated, Often associated with recovery.
Slide 4 - Pathology & Pathogenesis In mild cases- not much change in renal parenchyma- may be minimal tubular degeneration, mild renal parenchymal change & presence of vacuoles In severe cases- Tubular degeneration with distal tubular necrosis, Proximal tubules are often loaded with malarial pigments, Hb granules may be seen in the tubular cells
Slide 5 - Pathology & Pathogenesis 2 Most patients have little or no proteinuria & urinary sediment contains occasional granular and hyaline cast but no RBC. Absence of hypertension, Rapid resolution without residual impairment & predominant in adults rather than children with urinary findings suggests- ARF results from ATN & not glomerulonephritis
Slide 6 - Pathology & Pathogenesis 3 ARF- mediated thro’ several mechanisms 1.Effect of pRBC on microcirculation- knob like processes formation on surface of RBC which helps in anchoring the endothelium Cytoadherence- due to thrombospondin formation from vascular endothelium- specific to pf ( not in pv/pm) so ARF only in pf. Loss of deformability of pRBC according to need of microcirculation- slugish circulation- renal ischemia
Slide 7 - Pathology & Pathogenesis 4 2.Hypovolumia may occur due to Fever (hyperpyrexia), sweating, decreased intake of fluid, vomiting etc. 3.DIC 4.Increased plasma viscosity due to infection 5.Release of chemical mediators- TNF,cachectin, cytokines, interleukines etc causes- vasoconstriction, increased vascular permiability, catecholamine release(SIADH ) hemoconcentrarion, shock & tubular necrosis 6.Hyperbilirubinaemia due to hemolysis, Black water fever in G6 PD deficiency patients is also associated with ARF
Slide 8 - CLINICAL FEATURES ARF in severe malaria is common in adults, rare in children Two subsets of presentations- ARF as a component of multi organ failure present since admission- poor prognosis, associated with anemia, jaundice, hypoglycemia, acidosis or coma Present as a sole complication- appears at a later stage when other complications subsided/treated – prognosis is good
Slide 9 - CLINICAL FEATURES 2 Diagnosis suspected when urine output <400ml/24 hrs & confirmed when sr.creatinine >3mg/dl in adults & >1.5mg/dl in children Patient may be anuric, oliguric, with normal urination or polyuric Oliguric phase varies from few days to wks Prerenal azotemia presents with signs of dehydration Prolonged anuria/oliguria – volume over load due to decrease salt & water excretion
Slide 10 - CLINICAL FEATURES 3 Differentiation of prerenal & established ARF is important for management- sp.gr.of urine is >1.020 & <1.010 respectively Vulnerable group of patients- Pregnant women, b) high parasitemia, c) very high jaundice d) prolonged dehydration e) on NSAID therapy Patients with pfr +ve to be screened for ARF
Slide 11 - CRITICAL DETERMINANTS Hypo & hyper volumia Hyperparasitemia Hemoconcentration Hyperbilirubinemia Hyperpyrexia Hyperkalemia Hyponatremia
Slide 12 - LAB. INVESTIGATIONS & MONITORING Peripheral smear for diagnosis & parasite clearance Blood urea, creat., bilirubin, SGPT, Na,K, HCO3,PH Urine sp. Gr. ECG & chest X-ray when indicated
Slide 13 - TREATMENT (Guidelines) Appropriate antimalarial at the earliest Maintenance of fluid & electrolytes Recording of intake output chart Prevention of fluid overload & secondary infection including pneumonia Treatment of acquired infection at the earliest keeping an open mind
Slide 14 - TREATMENT 2 Meticulous record of fluid requirement- fluid intake, urine output –guides the administration of fluid, monitoring the improvement & most of all preventing fluid overload – a CVP line can be established Daily sr creat estimation in severe pf malaria cases if possible
Slide 15 - TREATMENT 3 If the 24hr urine output is <400ml & the patient is clinically dehydrated- Fluid challenge – 20ml/kg of Normal saline over one hr. Monitor for fluid overload after each 200ml by- Chest auscultation, JVP,CVP at 0 & +5 Urine output should be 20ml/hour
Slide 16 - TREATMENT 4 If no urine after fluid therapy- Diuretic challenge: Iv loop diuretic- Inj Furosemide in incremental dose 40-100-200-400mg at ½ hour interval If no improvement- Dopamine challenge: Inj dopamine slow iv infusion at 2.5 to 5mcg/kg/min
Slide 17 - RESPONSE 75%of oliguric & 5%of anuric responds with increased urine output No improvement in sr creat level False sense of improvement Reduces the risk of volume overload If ineffective further fluid is restricted
Slide 18 - CAUTION No benefit in oliguric patients No recovery in anuric patients Delay in decision for dialysis Complications of Dopamine- Gangrene, Ototoxicity
Slide 19 - CAUTION 2 Avoid Nephrotoxic drug in ARF suspects- ACE inhibitors & cyclooxygenase inhibitors (NSAIDs)- precipitate prerenal azotemia to ischemic ARF Cephalosporines & Aminoglycosides Assesment of renal function using urine output is dangerous in patients receiving Diuretics
Slide 20 - Antimalarial Drugs Qunine - Can be given safely in pregnancy & ARF - Initial dose of qunine -10mg/kg 8hrly - Reduction after 48 hrs No dose adjustment during HD Artemisinine No modification is required in ARF
Slide 21 - Indications for Dialysis Clinical : Uraemic symptoms- Nausea, Vomiting, Hiccough, Flapping tremors, Muscle twitching,& Convulsion Fluid overload Pericardial rub Arrhythmia Laboratory: Rising creatinine, Hyperkalemia, (K >6.5), Acidosis(HCO3 <15meq/l)
Slide 22 - Haemodialysis Advantages - Efficient method Disadvantages - Only in selected centers - Expertise - Lag time
Slide 23 - ppt slide no 23 content not found
Slide 24 - Caution for conservative management of ARF in severe malaria May develop critical signs at any odd hrs without giving a scope for dialysis Many patients have been lost as dialysis is decided but institution is delayed Sudden cardiac death may ensue in a patient who is improving due to pulmonary edema or hyperkalaemia
Slide 25 - PROGNOSIS Mortality among renal failure is 45% to 10% those without Death increases 3 fold in presence of ARF Very high mortality in presence of MOF Mortality can be reduced to 10% if early & frequent Dialysis is instituted Survival with PD is lower than HD
Slide 26 - Thank you