Clinical characteristics and treatment strategy of acute renal failure induced by crush syndrome after earthquake / 第三军医大学学报

ABSTRACT

Objective To retrospectively analyze the clinical characteristics of acute renal failure ( ARF) induced by crush syndrome after Wenchuan earthquake,and summarize the rational and effective treatment managements of this kind of ARF. Methods The case histories of 12 patients diagnosed as ARF related to the crush syndrome in Wenchuan earthquake were pigeonholed. In order to evaluate the curative effects of the clinical features,laboratorial examination,continuous renal replacement therapy ( CRRT) and cure time were ana- lyzed. Results Anaemia,fever and lung infection were frequently happened in the patients diagnosed as ARF,and the frequency was 91. 67% ,66. 67% and 58. 33% respectively. Pleural effusion and acute respiratory distress syndrome ( ARDS) were noted in 41. 67% of the patients,and the increase of transaminase was noted as 91. 67% . Hypocalcaemia,hypoproteinemia and marked increase of creatine kinase ( CK) appeared in all patients. The patients with CK value exceeded 3 000 IU/L were received CRRT,and there was marked relativity between these 2 variables ( r =0. 845) for the treatment of ARF. Although the proportion of CRRT practiced highly in patients with oliguria,fasciotomies and amputations,there was no significant difference when compared with closed injury and non-oliguria patients ( P = 0. 522 7) . Compared with patients without infections,wound infections were obviously delayed the cure time of ARF ( P = 0. 025 5) . Conclusion As compared with ARF from other causes,ARF related to the crush syndrome has unique characteristics,and easily complicates with multiple organ dysfunction syndrome. Among the treatments, heteropathy and renalreplacement therapy are frequently used. Thorough debridement and infection control are beneficial to renal function recovery.