Abstract
Many of the patients who were buried under fallen masonary in the Hanshin-Awaji earthquake of January 17, 1995, developed acute renal dysfunction. These patients were considered victims of “crush syndrome.” Although, crush syndrome has been reported during seismic catastrophes and wars, the mechanism of this disease has not been fully understood. In order to investigate the predictive factors of crush syndrome, a retrospective study of the charts of patients injured in the Hanshin-Awaji earthquake was performed. Fifty-nine patients in whom serum creatine kinase level was higher than 1, 000IU/l were studied. The emergency laboratory data and clinical background of those patients with renal dysfunction were compared with patients without renal dysfunction. Renal dysfunction was defined as levels of serum creatinine greater than 1.5mg/dl. When clinical variables were compared between the renal dysfunction and the non-renal dysfunction groups, average age, potassium level and white blood cells were significantly higher in the renal dysfunction group, while calcium, total protein and HCO3- in blood gas were significantly lower. When clinical variables were compared between those who died and those who survived, calcium was significantly lower in those who died. Because of the circumstances, the full range of medical care was not possible and was limited to what emergency units could provide. For instance, the serum enzyme level from muscles, such as LDH and GOT exceeded desirable limits in many cases in the renal dysfunction group. In conclusion, when patients suffer from crush injury, blood chemistry and gas analysis should be performed immedi-ately. If an extremely high level of musclogenic enzyme and a low level of serum calcium are observed, extreme caution should be used to prevent renal dysfuntion.
