Disaster nephrology: crush injury and beyond

Abstract

Disasters result in a substantial number of renal challenges, either by the creation of crush injury in victims trapped in collapsed buildings or by the destruction of existing dialysis facilities, leaving chronic dialysis patients without access to their dialysis units, medications, or medical care. Over the past two decades, lessons have been learned from the response to a number of major natural disasters that have impacted significantly on crush-related acute kidney injury and chronic dialysis patients. In this paper we review the pathophysiology and treatment of the crush syndrome, as summarized in recent clinical recommendations for the management of crush syndrome. The importance of early fluid resuscitation in preventing acute kidney injury is stressed, logistic difficulties in disaster conditions are described, and the need for an implementation of a renal disaster relief preparedness program is underlined. The role of the Renal Disaster Relief Task Force in providing emergency disaster relief and the logistical support required is outlined. In addition, the importance of detailed education of chronic dialysis patients and renal unit staff in the advance planning for such disasters and the impact of displacement by disasters of chronic dialysis patients are discussed.

PEGylated Artificial Antibodies: Plasmonic Biosensors with Improved Selectivity

“…Myoglobinuria is problematic in rhabdomyolysis due to a number of pathologic conditions and due to crush injury. 44 Concentrations of 10 μ g/mL myoglobin in urine are within the pathologic range contributing to kidney injury in humans. 44 Compared to non-PEGylated nanostructures, the PEGylated AuNRT imprinted with Hb, showed excellent resistance to (nonbinding of) both HSA and Mb (Figure 4B).…”

“…44 Concentrations of 10 μ g/mL myoglobin in urine are within the pathologic range contributing to kidney injury in humans. 44 Compared to non-PEGylated nanostructures, the PEGylated AuNRT imprinted with Hb, showed excellent resistance to (nonbinding of) both HSA and Mb (Figure 4B). The LSPR shift corresponding to nonspecific binding of HSA and Mb dropped from ∼1.9 nm to ∼0.2 nm and from ∼1.5 nm to ∼0.3 nm, respectively.…”

Disaster Management in a Nephrology Service: Lessons Learned from Hurricane Maria

“…This represents a challenge for the receiving units, as they must provide care to complicated patients with very little information and without having the benefit of a coordinated transfer of care. To address this, all dialysis patients should receive copies of their dialysis orders, medications, diet, allergies, and any additional important information at least 48 h before a major hurricane [9]. Preemptive evacuation should be considered for patients living in vulnerable areas and those who have limited mobility, since these patients will represent a challenge for emergency rescue once the hurricane makes landfall.…”

Wars, disasters and kidneys

“…The programme is embedded within the broader rescue support programme deployed by Médéçins sans Frontières, (Doctors without Borders). [50][51][52][53][54] Based on the cumulative and extensive experience with several of these interventions where the principles of early fluid resuscitation were applied, the task force has published recommendations for the logistical and medical management of crush syndrome victims in mass disasters. [53][54][55] During the London Blitz of 1940, crush syndrome was almost universally fatal, whereas by 1999 the mortality rate had been dramatically reduced to ,20%.…”

“…This was a major challenge following Hurricane Katrina, Cyclone Yasi, the Kobe and Marmara earthquakes, and the recent Tohuku earthquake and tsunami, which was followed by the Fukushima nuclear power plant meltdown (for review see. 50,54 In these situations, if possible, dialysis-dependent endstage renal disease patients must be transferred to other dialysis facilities, often in other cities, to continue their dialysis treatment. For example, relocation of chronic dialysis patients places significant pressures on receiving dialysis units.…”