Abstract
Acute kidney injury (AKI) is frequent, and shows wide variation with regards to the spectrum, etio-pathogenesis and management strategies after natural (e.g., earthquakes) and man-made disasters (e.g., wars). The most important pathogenetic mechanisms in AKI during earthquakes are crush injury-related hypovolemia and myoglobinuria. Therefore, the most effective preventive measures are early and energetic fluid resuscitation (especially isotonic saline due to medical and logistic advantages) and also avoiding nephrotoxic medications. When preventive measures fail and intrarenal AKI develops, dialysis is lifesaving, with a preference towards intermittent hemodialysis due to medical and logistic advantages during disasters. During wars, the most important man-made disaster, prerenal, intrarenal and postrenal AKI may develop both at the battlefield and also in the field- or tertiary care-hospital setting. Overall, pathogenesis and management strategies of AKI in war victims are similar with those of AKI in general and in natural disasters. Logistic planning after disasters is vital for providing the most effective treatment. If patients cannot be coped with locally, either help should be asked from, or, alternatively, patients should be referred to, other regions or countries. Importantly, nephrology units in and around disaster-prone areas should be prepared for disasters for a sudden influx of AKI victims after disasters.
Highlights
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Management of acute kidney injury (AKI) in disaster victims is problematic because, mostly, patients are complicated, medical infrastructure is damaged and there is a shortage of medical items and personnel [1]
According to this guideline, ensuring volume status and perfusion pressure, monitoring biochemical values, avoiding hyperglycemia and considering alternatives to radiocontrast procedures have been recommended in all stages of AKI
Summary
Management of acute kidney injury (AKI) in disaster victims is problematic because, mostly, patients are complicated, medical infrastructure is damaged and there is a shortage of medical items and personnel [1]. Mannitol may improve compartment syndrome and renal perfusion, interfere with cast formation and free radical production [9]; there are inconsistent reports on its usefulness in traumatic rhabdomyolysis [10] The efficacy of this early and energetic fluid resuscitation has been nicely shown in the Bingol earthquake, in Turkey, in 2003 [11]. The volume of administered fluids was significantly higher in the nondialyzed victims, all of who survived [11] Another very important AKI preventive maneuver in disaster victims is avoiding nephrotoxic medications. All dialysis modalities have both medical and logistic advantages and drawbacks in disaster victims with AKI (Table 1) [12].
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