• T Shimazu, T Yoshioka, Y Nakata, K Ishikawa, Y Mizushima, F Morimoto, M Kishi, M Takaoka, H Tanaka, A Iwai, and A Hiraide.
• Department of Traumatology, Osaka University Medical School, Japan.
• J Trauma. 1997 Apr 1;42(4):641-6.

BackgroundCrush syndrome is a form of traumatic rhabdomyolysis characterized by systemic involvement, in which acute renal failure is potentially life-threatening.MethodsClinical and laboratory data of 14 crush-syndrome patients transferred to a tertiary emergency department after the Hanshin-Awaji earthquake were analyzed. The patients were buried under collapsed houses for the average of 6.7 +/- 5.7 (SD) hours (range, 1 to 24 hours). They were referred to us 6 to 250 hours after the earthquake.ResultsOf those who arrived at our institution within 40 hours, 25% (two of eight) developed renal failure, whereas all six patients who arrived after 40 hours developed renal failure. Peak serum creatine kinase ranged from 6,677 to 134,200 U/L (51,674 +/- 41,776). Renal failure was highly associated with massive muscle damage (serum creatine kinase above 25,000 U/L) and insufficient initial fluid resuscitation (below 10,000 mL/2 days).ConclusionsPrompt and adequate, if not massive, fluid resuscitation is the key to preventing renal failure after such injury.

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