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

Abstract

Background: Crush syndrome (CS) is a systemic condition resulting from rhabdomyolysis caused by prolonged pressure on muscle tissue. It is estimated that CS will develop in approximately 2-5% of all injuries related to an earthquake, and acute kidney injury (AKI) will develop in approximately 1.5% of all injuries. The present study aimed to present the evaluation of pediatric patients with CS who developed AKI to determine the risk factors that can be determined beforehand for the need for dialysis and to present a new scoring developed for dialysis indication.

Methods: Pediatric patients with CS and who underwent dialysis for AKI were included in the study. The study was conducted retrospectively and as single-center data. A renal scoring system that determines the indications for dialysis in patients with CS by parameters of eGFR, creatine phosphokinase (CPK), time under rubble, presence of amputation or fasciotomy, and urine volume was included.

Results: The mean age was 11.53 ± 4.50 years, and 58.4% of the group were male. Among the 77 patients, 33 (42.8%) underwent kidney replacement therapy (KRT). Renal score, CPK level, and presence of myoglobinuria were determined to be the best markers for KRT indication in pediatric patients with CS (p < 0.01, p = 0.02, and p < 0.01, respectively).

Conclusions: We suggest that if a similar disaster occurs in the future, an easy and applicable renal scoring system can contribute to the prognosis by providing appropriate and early treatment for KRT. A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: Acute kidney injury; Crush syndrome; Dialysis; Disaster; Earthquake; Kidney replacement therapy.