Acute Renal Failure following Physical Torture

Abstract

Ten cases of acute renal failure (ARF) were seen in the period from July 1990 to August 1991 in the Nephrology Department of the SIMS Hospital, Srinagar. All were males in the age group of 18-28 years and in apparent good health when apprehended by the police. There was alleged history of physical torture of different types. All had been beaten on the buttocks, back and limbs; in addition, 2 cases had been given repeated electric shocks and 1 case put to ‘sit-and-stand’ exercise for about 3 h. The interval between the first day of torture till they came to our observation varied from 4 to 11 days. The main clinical features at the time of presentation were generalized aches and weakness (10), oligoanuria (9), vomiting (8), hypertension (6), acidosis (10), facial puffiness and pedal edema (6), fever and shivering (3), pulmonary edema (2), stupor (4), and hyperkalemia (5). All the cases had an established ARF (serum creatinine 668-1,997 μmol/l and serum urea 21.8-71.8 mmol/l) when first seen. Muscle enzymes, creatine phosphokinase, lactic dehydrogenase and serum glutamic oxaloacetic transaminase were all significantly raised indicating rhabdomyolysis. All showed evidence of myoglobin casts in urine. Nine had oliguric and 1 had nonoliguric ARF. All except the 1 case with nonoliguric ARF were managed with peritoneal dialysis and/or hemodialysis. All recovered. Early recognition of ARF is important since the main attention in such cases is directed towards the surgical aspect.

Utility of Urine Myoglobin for the Prediction of Acute Renal Failure in Patients with Suspected Rhabdomyolysis: A Systematic Review

“…Twenty studies looked at drugs or toxins (therapeutic/drugs of abuse, alcohol, insect venoms, snake venoms, heavy metals) (13, 14, 16, 18, 20 -23, 27, 28, 32, 33, 38, 43, 44, 52, 55, 56, 59, 63 ), 20 referred to trauma (crush injuries, motor vehicle accidents, surgery, physical torture and abuse, long-term confinement without changing position) (11, 21, 24 -26, 27, 29, 30, 34 -36, 38, 42, 44, 45, 48, 53, 54, 56, 59 ), 17 to infection (11,15,17,23,26,27,29,35,38,40,41,43,44,47,55,56,62 ), 12 to physical exertion (strainful muscle exercise, excessive muscle activity, seizures, longdistance running) (11, 23, 25-27, 30, 31, 38, 39, 43, 44, 49 ), 11 to metabolic disturbance (metabolic syndromes, endocrine disorders, electrolytes imbalances) (11,15,19,23,27,35,41,43,44,55,56 ), 9 to burns (thermal injury, high-voltage electrical injury, lightning) (19,26,35,38,46,48,50,57,58 ), 7 to asphyxiation (19,21,35,…”

Rhabdomyolysis in DOMS

“…Rhabdomyolysis is diagnosed by the detection of elevated serum-enzyme activity and in most instances overt myo-globinuria does not appear (20). In our case, the scintigraphic findings allowed to establish the suspected diagnosis of rhabdomyolysis, their confirmation by analytic and MRT, and the prevention of secondary complications.…”

Acute renal failure caused by prolonged djembe drumming

“…The major cause of extracorpuscular RBC destruction, however, is mechanical trauma. This can be found following implantation of mechanical heart valve [ 5 ], physical torture [ 6 ], left ventricular assist device use [ 7 ] and strenuous exercise [ 8 ]. Marching by soldiers is the classic example of strenuous exercise.…”