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Gorelik Y, Darawshi S, Yaseen H, et al. Acute Renal Failure Following Near-Drowning. Kidney Int Rep. 2018;3(4):833-840doi: 10.1016/j.ekir.2018.02.007.
Gorelik, Y., Darawshi, S., Yaseen, H., Abassi, Z., Heyman, S. N., & Khamaisi, M. (2018). Acute Renal Failure Following Near-Drowning. Kidney international reports, 3(4), 833-840. https://doi.org/10.1016/j.ekir.2018.02.007
Gorelik, Yuri, et al. "Acute Renal Failure Following Near-Drowning." Kidney international reports vol. 3,4 (2018): 833-840. doi: https://doi.org/10.1016/j.ekir.2018.02.007
Gorelik Y, Darawshi S, Yaseen H, Abassi Z, Heyman SN, Khamaisi M. Acute Renal Failure Following Near-Drowning. Kidney Int Rep. 2018 Mar 01;3(4):833-840. doi: 10.1016/j.ekir.2018.02.007. eCollection 2018 Jul. PMID: 29989059; PMCID: PMC6035158.
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Kidney Int Rep. 2018 Mar 01;3(4):833-840. doi: 10.1016/j.ekir.2018.02.007. eCollection 2018 Jul.

Acute Renal Failure Following Near-Drowning.

Kidney international reports

Yuri Gorelik, Said Darawshi, Hiba Yaseen, Zaid Abassi, Samuel N Heyman, Mogher Khamaisi

Affiliations

  1. Internal Medicine, Rambam Health Care Campus, Haifa, Israel.
  2. Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa, Israel.
  3. The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel.
  4. Departments of Medicine, Hadassah Hebrew University Hospitals, Jerusalem, Israel.

PMID: 29989059 PMCID: PMC6035158 DOI: 10.1016/j.ekir.2018.02.007

Abstract

INTRODUCTION: Acute kidney injury associated with near-drowning (ND-AKI) has rarely been reported and its incidence among survivors is unknown. A patient with AKI and urine biomarkers indicating tubular injury led us to assess the occurrence and clinical characteristics of ND-AKI and to evaluate possible causative mechanisms.

METHODS: We evaluated medical records of patients rescued from near-drowning in the Mediterranean Sea and treated in a tertiary-level medical center during 2000 to 2017.

RESULTS: Ninety-five patients with the diagnosis of near-drowning in seawater were treated. Forty-two of these patients (43%) developed ND-AKI and 17 (18%) were classified as AKI Kidney Disease: Improving Global Outcomes stages 2 to 3. ND-AKI was associated with the need for resuscitation and mechanical ventilation, with the calculated seawater volume ingestion (extrapolated from rising plasma sodium) and with the degree of acidemia, lactemia, and ventilatory failure. This series and 28 additional published cases of ND-AKI in the literature showed an overall male predisposition.

CONCLUSION: AKI is a common complication of near-drowning and is associated with increased in-hospital mortality. Data analysis suggests a predominant role of hypoxic tubular injury due to systemic hypoxemia in ND-AKI, combined with intense sympathetic activity (reflected by tachyarrhythmias, hyperglycemia, and relative hypokalemia) and increased oxygen expenditure for intensified distal tubular sodium transport. Androgen-related reduced renal vasodilatory capacity may explain male gender predominance.

Keywords: acute kidney injury; gender; hypoxia; rhabdomyolysis

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