Transactions of the Royal Society of Tropical Medicine and Hygiene (2004) 98, 255—260 Polyuria in association with Plasmodium falciparum malaria in a region of unstable transmission K. Grimwade a,b , N. French b , D. Mthembu a , C. Gilks c, * a Hlabisa Hospital, KwaZulu Natal, South Africa b Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK c Imperial College of Science, Technology and Medicine, London W2 1PG, UK Received 25 April 2003; received in revised form 30 September 2003; accepted 30 September 2003 KEYWORDS Malaria; Plasmodium falciparum; Polyuria; Renal impairment; Africa Summary During a recent epidemic of Plasmodium falciparum malaria in Hlabisa district, KwaZulu Natal, polyuria was recognized in a subset of adults presenting to hospital with severe disease. In January to May 2000, following consent, cases of severe malaria provided blood spots for HIV testing, clinical data, and blood and urine samples for investigation of the polyuria. Four hundred and eleven adults with malaria were admitted, of whom 175 had severe malaria and 37 had polyuria (21% of severe cases). In those with polyuria the mean 24-h urine output was 3018 ml or 2.85ml/kg/h. Ten of 15 (66%) patients investigated had urine and plasma osmo- lalities consistent with diabetes insipidus. There was no significant association be- tween polyuria and sex, age, HIV status or features of severe malaria. Whether the polyuria in these non-immune adults is a localized problem unrelated to malaria, or a hitherto unrecognized complication of severe malaria is not clear. Physicians are alerted to this observation, and the need for more clinical and pathophysiological studies. © 2004 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved. 1. Introduction Renal impairment is a recognized complication of Plasmodium falciparum malaria. Classically this is pre-renal failure, developing as a consequence of dehydration combined with complex inflam- matory and immunological intra-renal insults and * Corresponding author. Present address: Department of HIV/AIDS, World Health Organization, CH-1211 Geneva 27, Switzerland. E-mail addresses: kategrimwade@aol.com (K. Grimwade), nfrench@mlw.medcol.mw (N. French), gilksc@who.int (C. Gilks). which typically manifests with oliguria and/or de- rangement of renal function tests. In these cir- cumstances, rapid development of fluid overload frequently accompanies over-zealous rehydration. With appropriate management however, renal function usually recovers, during which period polyuria is observed. We describe a series of adult patients during an outbreak of epidemic malaria in South Africa, where polyuria was a presenting clinical feature in the absence of oliguric renal failure. Inappropriate fluid management may have contributed to adverse outcome, therefore further surveillance for this presentation is warranted in areas of unstable malaria transmission. 0035-9203/$ — see front matter © 2004 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved. doi:10.1016/S0035-9203(03)00067-1