Acute renal failure during the Korean War

Area of Science:

• Nephrology
• Trauma Surgery
• Critical Care Medicine

Background:

• Acute Renal Failure (ARF) presented a grave threat to battle casualties, escalating mortality rates significantly.
• Fluid volume overload and myocardial potassium intoxication were identified as primary causes of death in ARF patients.

Observation:

• Oliguric ARF occurred in 0.5% of casualties reaching field medical care, with mortality rising from <5% to ~90%.
• Renal function impairment correlated with wound severity and blood loss.
• Oliguria duration varied from 3 days to 3 weeks, with no clear peak for diuresis onset.

Findings:

• Post-traumatic catabolism accelerated extracellular accumulation of nitrogen, potassium, phosphate, and hydrogen ions during oliguria, leading to rapid clinical decline.
• Dialysis, when initiated based on specific indications, resulted in fluctuating clinical and chemical parameters.
• ARF was characterized as a wasting disease, complicated by infections, delayed wound healing, anemia, bleeding, and hypertension.

Implications:

• The establishment of a Renal Insufficiency Center with dialysis capabilities marked a significant advancement in managing ARF in combat settings.
• Effective treatment strategies, including dialysis, were shown to reduce the overall mortality rate for battle casualties with ARF.
• Understanding ARF as a complex wasting disease highlighted the need for comprehensive patient management beyond renal replacement therapy.