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Acute Renal Failure Following Near-Drowning
Yuri Gorelik1, Said Darawshi1, Hiba Yaseen2
1Internal Medicine, Rambam Health Care Campus, Haifa, Israel.
Kidney International Reports
|July 11, 2018
Summary
Acute kidney injury (AKI) is a common complication following near-drowning incidents, particularly in males. Hypoxic tubular injury due to low oxygen levels is the primary cause, leading to increased mortality.
Area of Science:
- Nephrology
- Emergency Medicine
- Environmental Health
Background:
- Acute kidney injury associated with near-drowning (ND-AKI) is rarely reported, with unknown incidence.
- A case of AKI with tubular injury markers prompted an investigation into ND-AKI.
Purpose of the Study:
- To assess the occurrence and clinical characteristics of ND-AKI.
- To evaluate the potential causative mechanisms of ND-AKI.
Main Methods:
- Retrospective evaluation of medical records of near-drowning patients treated at a tertiary medical center (2000-2017).
Main Results:
- 43% of 95 near-drowning patients developed ND-AKI; 18% had severe AKI (KDIGO stages 2-3).
- ND-AKI correlated with resuscitation needs, mechanical ventilation, seawater ingestion volume, acidemia, lactemia, and ventilatory failure.
- Literature review of 28 additional cases revealed a male predominance.
Conclusions:
- AKI is a frequent complication of near-drowning, increasing in-hospital mortality.
- Hypoxic tubular injury from systemic hypoxemia, sympathetic overactivity, and increased renal oxygen demand are key factors.
- Androgen-related reduced renal vasodilatory capacity may explain male predominance.
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