Post-traumatic renal insufficiency in military casualties

Teschan, Paul E.; Post, Robert S.; Smith, Lloyd H.; Abernathy, Robert S.; Davis, John H.; Gray, Dell M.; Howard, John M.; Johnson, Kenneth E.; Klopp, Edward H.; Mundy, Roy L.; O'Meara, Maurice P.; Rush, B. F.

doi:10.1016/0002-9343(55)90233-3

Cited by 151 publications

(28 citation statements)

References 26 publications

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“…All but one of the survivors (98%) recovered renal function and discontinued dialysis. Renal recovery was similar to that previously reported in military casualties (1)(2)(3)5,(7)(8)(9). In civilian series, .90% of patients recover renal function before discharge, even though many had comorbidities that increased ESRD risk (10)(11)(12)14,29,30).…”

Section: Discussionsupporting

confidence: 85%

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Outcomes After Post-Traumatic AKI Requiring RRT in United States Military Service Members

Bolanos

Yuan

Little

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Mortality and CKD risk have not been described in military casualties with posttraumatic AKI requiring RRT suffered in the Iraq and Afghanistan wars.Design, setting, participants, & measurements This is a retrospective case series of post-traumatic AKI requiring RRT in 51 military health care beneficiaries (October 7, 2001-December 1, 2013, evacuated to the National Capital Region, documenting in-hospital mortality and subsequent CKD. Participants were identified using electronic medical and procedure records.Results Age at injury was 2666 years; of the participants, 50 were men, 16% were black, 67% were white, and 88% of injuries were caused by blast or projectiles. Presumed AKI cause was acute tubular necrosis in 98%, with rhabdomyolysis in 72%. Sixty-day all-cause mortality was 22% (95% confidence interval [95% CI], 12% to 35%), significantly less than the 50% predicted historical mortality (P,0.001). The VA/NIH Acute Renal Failure Trial Network AKI integer score predicted 60-day mortality risk was 33% (range, 6%-96%) (n=49). Of these, nine died (mortality, 18%; 95% CI, 10% to 32%), with predicted risks significantly miscalibrated (P,0.001). The area under the receiver operator characteristic curve for the AKI integer score was 0.72 (95% CI, 0.56 to 0.88), not significantly different than the AKI integer score model cohort (P=0.27). Of the 40 survivors, one had ESRD caused by cortical necrosis. Of the remaining 39, median time to last follow-up serum creatinine was 1158 days (range, 99-3316 days), serum creatinine was 0.8560.24 mg/dl, and eGFR was 118623 ml/min per 1.73 m 2 . No eGFR was ,60 ml/min per 1.73 m 2 , but it may be overestimated because of large/medium amputations in 54%. Twenty-five percent (n=36) had proteinuria; one was diagnosed with CKD stage 2.Conclusions Despite severe injuries, participants had better in-hospital survival than predicted historically and by AKI integer score. No patient who recovered renal function had an eGFR,60 ml/min per 1.73 m 2 at last follow-up, but 23% had proteinuria, suggesting CKD burden.

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Section: Discussionsupporting

confidence: 85%

“…PTAKI-associated mortality in casualties requiring RRT has been 63%-75% since the Korean conflict (1,2). Although mortality is unchanged, casualties are increasingly severe, associated with improved resuscitation, surgical, and evacuation capabilities (3)(4)(5)(6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Outcomes After Post-Traumatic AKI Requiring RRT in United States Military Service Members

Bolanos

Yuan

Little

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…Acute hemodialysis was first used clinically during the Korean War in 1950 to treat military casualties, and this led to a decrease in mortality of the ARF clinical syndrome from about 90% to about 50% (2,3). In the half century that has since passed, much has been learned about the pathogenesis of ischemic and nephrotoxic ARF in experimental models, but there has been very little improvement in mortality.…”

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confidence: 99%

Acute renal failure: definitions, diagnosis, pathogenesis, and therapy

Schrier¹,

Wang²,

Poole³

et al. 2004

J. Clin. Invest.

606

333

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Acute renal failure (ARF), characterized by sudden loss of the ability of the kidneys to excrete wastes, concentrate urine, conserve electrolytes, and maintain fluid balance, is a frequent clinical problem, particularly in the intensive care unit, where it is associated with a mortality of between 50% and 80%. In this review, the epidemiology and pathophysiology of ARF are discussed, including the vascular, tubular, and inflammatory perturbations. The clinical evaluation of ARF and implications for potential future therapies to decrease the high mortality are described.

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“…Among the factors which may significantly accelerate protein catabolism in acute renal failure are infection, tissue necrosis, and stress of acute illness (24)(25)(26). Another possible determinant of catabolic response is the state of nutrition at the onset of oliguria, catabolic rate being probably greater in the previously well-nourished patients than in those previously debilitated by chronic disease (23).…”

Section: +20mentioning

confidence: 99%

Changes in Body Composition in Acute Renal Failure 1

Bluemle¹,

Potter²,

Elkinton³

1956

J. Clin. Invest.

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To a large degree the therapy of acute renal failure depends on an understanding of biochemical disturbances that result from the temporary absence of renal excretory and homeostatic functions. Important among these disturbances are changes in the volume and composition of body fluids, particularly with respect to electrolyte constituents. While certain manifestations of these changes are frequently recognized on the clinical level, relatively little quantitative data are available from which can be derived a general pattern of body fluid alterations in this disease. One reason for this paucity of information, aside from the limitations of investigative techniques, is the inherent difficulty of performing adequate studies on critically ill patients.Sirota and Kroop (1) observed in 4 oliguric patients an expansion of inulin space roughly commensurate with estimated positive fluid balance. They postulated that the oliguric phase of acute renal failure is associated with cellular dehydration resulting from a shift of water out of cells, and that hyponatremia may result in part from extracellular dilution and in part from a shift of sodium into cells. The observation by Schwartz, Tomsovic, and Schwartz (2) of greater expansion of inulin space than of D20 space in one anuric child would conform with this concept. Iseri, Batchelor, Boyle, and Myers (3) also suggested that the hyponatremia and hypochloremia of oliguria may be due in part to cellular uptake of sodium and shift of water from cells to extracellular fluid. The role of catabolism in augmenting total body water through water of oxidation and release of preformed water was evaluated by Hamburger and Richet (4), largely by inference from observations made during post-oliguric diuresis. Changes in the volume and distribution of body water were also studied in anuric dogs by Hamburger and Mathe (5), who found close agreement between the expansion of total body water as measured by D20 spaces and the amount of water derived from metabolic processes. On the basis of extensive clinical observation and a limited number of isotopic dilution studies, Merrill (6) has enumerated some of the fluid and electrolyte changes frequently seen in prolonged acute renal failure, as follows: 1) an increase in total body water, 2) an increase in total body sodium with a decreasing serum concentration, 3) a decrease in total body potassium with an elevated serum level, and 4) an increased extracellular fluid volume.The primary purpose of the present study was to obtain more complete information

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Post-traumatic renal insufficiency in military casualties

Cited by 151 publications

References 26 publications

Outcomes After Post-Traumatic AKI Requiring RRT in United States Military Service Members

Outcomes After Post-Traumatic AKI Requiring RRT in United States Military Service Members

Acute renal failure: definitions, diagnosis, pathogenesis, and therapy

Changes in Body Composition in Acute Renal Failure 1

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