Post-traumatic renal insufficiency in military casualties: II. Management, use of an artificial kidney, prognosis

Abstract

1. 1. The management of fifty-one patients with post-traumatic renal insufficiency included fluid restriction, attempts to maintain caloric intake, use of cation exchange resins, the treatment of anemia and electrolyte disturbances and the use of a Brigham-Kolff artificial kidney. Interval surgical care of these patients was of great importance not only because of the severity of their wounds but particularly because of the necessity for removing necrotic and infected tissue in patients with renal failure. 2. 2. Dialysis with the artificial kidney was carried out seventy-two times in thirty-one patients of this series. It was effective in restoring clinical and chemical abnormalities toward normal and seemed to contribute to the reduction in mortality in this group of patients. 3. 3. The mortality rate accompanying acute renal failure in military casualties in Korea was approximately 80 to 90 per cent, similar to the mortality rate during World War II. After establishment of a Renal Insufficiency Center and with the use of a Brigham-Kolff type artificial kidney, the over-all mortality rate in the fifty-one patients was 53 per cent. 4. 4. The limiting factor in survival for most military patients with acute renal failure is the extent of the underlying wounds with attending infection and impaired wound healing.