Disasters and crush syndrome-related acute kidney injury: What pediatric nephrologists should know

Crush syndrome and associated acute kidney injury (AKI) represent major causes of morbidity and mortality following disasters, particularly earthquakes. While crush syndrome has been extensively described in adults, pediatric aspects remain under-recognized despite children constituting a large proportion of disaster victims. This review provides an overview of current evidence on the epidemiology, pathophysiology, diagnosis, and management of crush-related AKI in children. Epidemiological data from past earthquakes, including the 1999 Marmara and 2023 Türkiye-Syria events, indicate that nearly half of pediatric patients with crush syndrome developed AKI, with a substantial proportion requiring dialysis. Importantly, crush-related AKI differs from other etiologies of AKI by its distinctive pathogenesis, rapid onset, and potential of life-threatening systemic complications. Unique pediatric considerations include age-specific patterns of injury, logistical barriers in providing pediatric dialysis, susceptibility to fluid and electrolyte disturbances and increased psychosocial burdens. Early and aggressive fluid resuscitation, timely initiation of kidney replacement therapy, and close monitoring for surgical, infectious and metabolic complications are essential. Pediatric nephrologists play a critical role not only in delivering direct patient care but also in disaster preparedness and staff training. National and international pediatric nephrology societies should advocate education on crush-related AKI and support collaboration with centers in affected areas during the acute phase of disasters.