Resumo

TOBON CASTANO, Alberto; DEL MAR CORTINA, Ana; FELIPE MIRANDA, Andrés  e  BLAIR TRUJILLO, Silvia. Dark urine and jaundice as warning signs in Plasmodium falciparum malaria in Colombia. Rev Cubana Med Trop [online]. 2010, vol.62, n.1, pp. 35-46. ISSN 1561-3054.

INTRODUCTION: early recognition of warning signs in malarial patients allows timely identification of the patient at risk of severe malaria and provides opportune treatment. Jaundice and dark urine are frequent signs that can alert to the occurrence of severe malaria. OBJECTIVE: to study the relationship between jaundice and dark urine with impaired liver and/or kidney function and anemia in malarial patients, and explore their role as warning signs. METHOD: clinical and laboratory data from 199 patients with Plasmodium falciparum malaria, belonging to a case control study conducted in Colombia, were analyzed. the association between dark urine and jaundice with impairment in the urine analysis, the hepatic and renal function test, and hemoglobin were studied. RESULTS: there was association between dark urine and hemoglobinuria (OR= 236, 63-867), hematuria (OR=3.2, 1.6-6.6), proteinuria (OR= 2.3, 1-5.3) and bilirubinuria (OR=2.1, 1-4.4). Jaundice was present in 31% of patients who had renal dysfunction (OR= 2.7, 1.1-6.4) and in 22 % of those with liver dysfunction (OR= 2.1, 0.9-4.5). Jaundice was more likely in patients with total bilirubin > 25.6 µmol/L (OR= 6.1, 2.7-13.4) and blood ureic nitrogen > 7.14 mmol/L (OR= 3.5, 1.4-8.5). CONCLUSIONS: jaundice in patients with malaria may be considered as a warning sign associated with liver and kidney dysfunction. Dark urine was not associated with kidney or liver dysfunction, but was related to bilirubinuria, hematuria and proteinuria, which can be early indicators of failure; dark urine must be studied to clarify its relationship with liver and kidney failure in malaria.

Palavras-chave : malaria; Plasmodium falciparum; clinical medicine; warning signs; jaundice; dark urine.

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