Acute Renal Failure Complicating Rickettsial Infections in Glucose-6-Phosphate Dehydrogenase-Deficient Individuals

Two cases of acute renal failure in glucose-6-phosphate dehydrogenase (G-6-PD)-deficient American Negro soldiers are reported. Massive intravascular hemolysis in these patients was not due to hemolytic drugs—including antimalarial agents—but was associated with murine typhus in one case and with scrub typhus in the other. This association is described for the first time. Peritoneal dialysis was effective in treating the acute renal failure in both cases. A phenomenon of decreased peritoneal solute clearance (urea and creatinine) during the acute hemolytic renal failure phase of the illness was noted; however, it was seen that with subsequent clinical improvement, peritoneal solute clearances returned to the usual range. The pathogenesis of the renal failure in these patients remains speculative and may be due to the extensive intravascular hemolysis with filtration of large quantities of hemoglobin and hemoglobin cast formation superimposed on a rickettsial-induced vasculitis in the kidney.