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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2013  |  Volume : 24  |  Issue : 5  |  Page : 1012-1014
Earthquake: Post-crisis renal failure

Wiwanitkit House, Bangkhae, Bangkok, 10160, Thailand

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Date of Web Publication12-Sep-2013

How to cite this article:
Wiwanitkit S, Wiwanitkit V. Earthquake: Post-crisis renal failure. Saudi J Kidney Dis Transpl 2013;24:1012-4

How to cite this URL:
Wiwanitkit S, Wiwanitkit V. Earthquake: Post-crisis renal failure. Saudi J Kidney Dis Transpl [serial online] 2013 [cited 2022 Jan 17];24:1012-4. Available from: https://www.sjkdt.org/text.asp?2013/24/5/1012/118077
To the Editor ,

Earthquake is classified as an important natural disaster. Many big earthquakes in the history have killed and injured numerous people. The earthquake crisis in early January in Haiti is the present concern. More than 150,000 deaths are expected from this current disaster. From the nephrological viewpoint, the topic of renal failure following an earthquake is of interest. In this brief article, the author hereby summarizes the details on this topic.

What is the "post-earthquake renal failure"?

Post-earthquake renal failure might not be a familiar term to many nephrologists. The renal failure that is seen in the post-earthquake stage is a specific medical disorder labeled the "Crush syndrome." Indeed, the crush syndrome can be seen in other kinds of natural disasters that lead to severe injury to the affected subjects. Acute renal failure (ARF) is an important manifestation of the crush syndrome. [1],[2] The pathogenesis of ARF in the crush syndrome is commonly due to rhabdomyolysis. [3] Early diagnosis and prompt treatment are helpful in achieving good outcome. Proper management comprises early aggressive hydration, urine alkalinization and, when possible, forced diuresis. [1]

There are many reports on the crush syndrome and ARF in the medical literature. These include the reports on the post-earthquake crises in Italy in 1987, [4] in China in 1987 [5] and 2009, [6],[7] in India in 2006, [8] in Iran in 2008, [9],[10],[11] etc. For the current crisis in Haiti, there is still no official report, but the number of affected individuals is expected to be large.

Diagnosis of post-earthquake renal failure

There is no difference in the definition of ARF after an earthquake. However, the important concern is the shortage of laboratory tools after the disaster and the associated destruction of medical infrastructure. The use of medical diagnostic tools is usually limited and has to be imported from external sites. Using the new point of care testing analyzers might help solve the problem of diagnosis in the post-crisis period. [12]

For diagnosis, it is observed that if ARF were to develop, the myoglobin level will increase by several folds. [13] Najafi et al recently proposed on a new, two-decision rule to predict the development of ARF in earthquake victims. [10] These rules are: If on Day 1 the serum creatinine was <2 mg/dL, LDH was <2000 IU and serum uric acid was <6 mg%, the risk for the development of ARF was virtually nil. Using multiple regression analysis, the equation: (0.45 CPK + 2.5 LDH + 2700 K + 2000 uric acid - 14,000)/ 10,000 was most predictive for serum creatinine on Day 3. Dichotomizing this value at 2.0 yielded a sensitivity and specificity for the prediction of ARF of 96.6% and 95.7%, respectively.[10] These rules are approved for the validity and reliability and are suggested for application in post-earthquake crisis. [14],[15]

Treatment of post-earthquake renal failure

As noted earlier, early diagnosis can lead to better therapeutic outcome. [1] Shimazu et al reported that renal failure was associated with massive muscle damage (serum creatinine kinase above 25,000 U/L) and insufficient initial fluid input (below 10,000 mL/2 days). [16] It is said that the ARF can be prevented by timely rehydration and bicarbonate therapy. [15] Gunal et al reported their experience from Turkey, stating that early and vigorous fluid resuscitation followed by mannitol-alkaline diuresis prevents ARF in crush victims, resulting in a more favorable outcome. [17] However, Ensari et al reported that even delayed application of aggressive specific fluid treatment under close monitoring could also effectively prevent the occurrence of ARF. [18] Hemodialysis might be considered in severe cases. [19] Yurugen et al reported that fluid overload and azotemia were the leading indications for hemodialysis, and subclavian catheterization is used commonly due to severely injured extremities after an earthquake. [20] For monitoring the effectiveness of fluid therapy, the use of a myoglobin test is suggested. [13] Normal myoglobin levels must be achieved before discharge. [13] It should also be noted that the decrease of myologin is not related to the hemodialysis treatment. [20]

Outcome of post-earthquake renal failure

In post-earthquake renal failure, if early fluid resuscitation is given, favorable outcomes are usually achieved. Shimazu et al reported favorable outcome with the standard recommended fluid therapy despite the long delay to initiation of intensive therapy, and also reported that weaning of hemodialysis could be done in affected cases within 6 months. [19] In another series by Kazancioglu et al, a low death rate (23% and 20% in dialyzed and non-dialyzed cases, respectively) could be seen. Kazancioglu et al noted that the death rate from ARF could be decreased by regular follow-up. [21]

   References Top

1.Scapellato S, Maria S, Castorina G, Sciuto G. Crush syndrome. Minerva Chir 2007;62:285-92.  Back to cited text no. 1
2.Gonzalez D. Crush syndrome. Crit Care Med. 2005;33:S34-41.  Back to cited text no. 2
3.Efstratiadis G, Voulgaridou A, Nikiforou D, Kyventidis A, Kourkouni E, Vergoulas G. Rhabdomyolysis updated. Hippokratia 2007;11: 129-37.  Back to cited text no. 3
4.Busetti L, Cardona O, Favazza A, Giordano F, Pian F, Sauli M. The crush syndrome. Experience in the earthquake of May 6, 1976 in Friuli. Minerva Anestesiol 1978;44:237-50.  Back to cited text no. 4
5.Sheng ZY. Medical support in the Tangshan earthquake: A review of the management of mass casualties and certain major injuries. J Trauma 1987;27:1130-5.  Back to cited text no. 5
6.Li W, Qian J, Liu X, et al. Management of severe crush injury in a front-line tent ICU after 2008 Wenchuan earthquake in China: An experience with 32 cases. Crit Care 2009;13:R178.  Back to cited text no. 6
7.Liu F, Gao FB, Fu P, et al. Isolated non-compaction of ventricular myocardium in a victim of the Wenchuan earthquake with crush syndrome and acute renal failure. Chin Med J (Engl) 2009;122:2196-8.  Back to cited text no. 7
8.Vanholder R. Intervention of the renal disaster relief task force (RDRTF) in the Kashmir earthquake. Nephrol Dial Transplant 2006;21:40.  Back to cited text no. 8
9.Sagheb MM, Sharifian M, Roozbeh J, Moini M, Gholami K, Sadeghi H. Effect of fluid therapy on prevention of acute renal failure in Bam earthquake crush victims. Ren Fail 2008;30: 831-5.  Back to cited text no. 9
10.Najafi I, Van Biesen W, Sharifi A, et al. Early detection of patients at high risk for acute kidney injury during disasters: Development of a scoring system based on the Bam earthquake experience. J Nephrol 2008;21:776-82.  Back to cited text no. 10
11.Tahmasebi MN, Kiani K, Mazlouman SJ, et al. Musculoskeletal injuries associated with earthquake. A report of injuries of Iran's December 26, 2003 Bam earthquake casualties managed in tertiary referral centers. Injury 2005;36:27-32.  Back to cited text no. 11
12.Kost GJ, Hale KN, Brock TK, et al. Point-of-care testing for disasters: Needs assessment, strategic planning, and future design. Clin Lab Med 2009;29:583-605.  Back to cited text no. 12
13.Binnitskiĭ LI, Egorov IA, Bronskaia LK. Myoglobin concentration in blood: A criterion in the evaluation of muscular tissue injury in patients with prolonged crush syndrome. Anezteziol Reanimatol 1995;4:47-9.  Back to cited text no. 13
14.Ito J, Fukagawa M. Predicting the risk of acute kidney injury in earthquake victims. Nat Clin Pract Nephrol 2009;5:64-5.  Back to cited text no. 14
15.Atef-Zafarmand A, Fadem S. Disaster nephrology: Medical perspective. Adv Ren Replace Ther 2003;10:104-16.  Back to cited text no. 15
16.Shimazu T, Yoshioka T, Nakata Y, et al. Fluid resuscitation and systemic complications in crush syndrome: 14 Hanshin-Awaji earthquake patients. J Trauma 1997;42:641-6.  Back to cited text no. 16
17.Gunal AI, Celiker H, Dogukan A, et al. Early and vigorous fluid resuscitation prevents acute renal failure in the crush victims of catastrophic earthquakes. J Am Soc Nephrol 2004;15:1862-7.  Back to cited text no. 17
18.Ensari C, Tufekçioglu O, Ayli D, Gümüs T, Izdes S, Turanli S. Response to delayed fluid therapy in crush syndrome. Nephron 2002;92:941-3.  Back to cited text no. 18
19.Shimazu T, Yoshioka T, Nakata Y, et al. Fluid resuscitation and systemic complications in crush syndrome: 14 Hanshin-Awaji earthquake patients. J Trauma 1997;42:641-6.  Back to cited text no. 19
20.Shigemoto T, Rinka H, Matsuo Y, et al. Blood purification for crush syndrome. Ren Fail 1997;19:711-9  Back to cited text no. 20
21.Yurugen B, Emir G, Ersoy A. Treatment of patients with acute renal failure during Marmara earthquake. EDTNA ERCA J 2001;27:174-7.  Back to cited text no. 21

Correspondence Address:
Viroj Wiwanitkit
Wiwanitkit House, Bangkhae, Bangkok, 10160
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DOI: 10.4103/1319-2442.118077

PMID: 24029274

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