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Is the renal score predictive for kidney replacement therapy in pediatric patients with crush syndrome?

Deniz Karakaya1, Aysun Çaltık Yılmaz1, Tülin Güngör1

  • 1Department of Pediatric Nephrology, Ankara Etlik City Hospital, Ankara, Turkey.

Pediatric Nephrology (Berlin, Germany)
|July 25, 2023
PubMed

Insights

A new renal scoring system can help predict the need for dialysis in pediatric crush syndrome patients with acute kidney injury. This system identifies key markers like CPK levels and myoglobinuria for early intervention.

Area of Science:

  • Pediatric Nephrology
  • Trauma Medicine
  • Disaster Medicine

Background:

  • Crush syndrome (CS) results from rhabdomyolysis due to prolonged muscle pressure, often seen after disasters like earthquakes.
  • Acute kidney injury (AKI) is a common complication of CS, affecting approximately 1.5% of earthquake-related injuries.
  • Identifying risk factors for dialysis in pediatric CS patients with AKI is crucial for timely management.

Purpose of the Study:

  • To evaluate pediatric patients with CS and AKI who required dialysis.
  • To determine predictive risk factors for dialysis necessity in this population.
  • To introduce and validate a novel renal scoring system for dialysis indication in CS.

Main Methods:

  • Retrospective, single-center study including pediatric CS patients who underwent dialysis for AKI.
  • Development of a renal scoring system based on estimated glomerular filtration rate (eGFR), creatine phosphokinase (CPK), time under rubble, amputation/fasciotomy status, and urine volume.
  • Analysis of patient data to identify significant markers for kidney replacement therapy (KRT).

Main Results:

  • The study included 77 pediatric patients, with 42.8% requiring KRT.
  • Higher renal scores, elevated CPK levels, and the presence of myoglobinuria were significant predictors for KRT indication (p < 0.01, p = 0.02, p < 0.01, respectively).
  • Mean age was 11.53 years, and 58.4% of the patients were male.

Conclusions:

  • The proposed renal scoring system can aid in early and appropriate treatment decisions for KRT in pediatric CS patients.
  • Implementing this scoring system may improve patient prognosis following disasters.
  • Early identification of patients needing dialysis is vital for managing AKI in crush syndrome.
Abstract

Keywords:
Acute kidney injuryCrush syndromeDialysisDisasterEarthquakeKidney replacement therapy

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