Acute renal failure due to crush syndrome during Marmara earthquake

During the earthquake in Marmara, Turkey (August 17, 1999), 87 of 476 victims (18.3%) admitted to Marmara University Hospital (Istanbul, Turkey) experienced renal failure caused by crush injuries. Fifty-nine patients (68%; 40 men, 19 women) required renal replacement therapy (RRT), whereas 28 patients (32%; 20 men, 16 women) recovered renal function under conservative treatment. The aim of the present study is to compare clinical and laboratory data from patients with crush syndrome who needed RRT with those who could be maintained on conservative medical treatment. Data for demographic, clinical, and laboratory findings of patients who had renal problems were collected retrospectively and analyzed. The proportion of men was significantly greater (68% versus 42%; P < 0.05), and time spent under the rubble was significantly shorter (9.4 +/- 6.9 versus 19.1 +/- 22.5 hours; P < 0.05) among patients who required RRT compared with those who recovered under conservative treatment. Patients who required RRT had significantly less urine output in the first 24 hours, underwent more fasciotomies, and needed more blood and fresh frozen plasma transfusions (P < 0.05). Blood urea nitrogen, creatinine, potassium, creatine kinase, and aspartate aminotransferase levels were significantly greater compared with patients managed conservatively both on admission and for the mean of values obtained during the first 2 weeks (P < 0.05). Furthermore, fasciotomies were the most powerful predictors of a later need for RRT. In a similar disaster in the future, these factors should be taken into consideration for priority in referral to medical centers with dialysis facilities.