Post-traumatic renal insufficiency in military casualties. II. Management,use of an artificial kidney,prognosis |
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| Authors: | SMITH L H POST R S TESCHAN P E ABERNATHY R S DAVIS J H GRAY D M HOWARD J M JOHNSON K S KLOPP E MUNDY R L O'MEARA M P RUSH B F |
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| Affiliation: | 1. Liver Diseases Branch, Division of Intramural Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 9000 Rockville Pike, Bldg. 10 Rm. 9B16, Bethesda, MD 20892, USA;2. Division of Gastroenterology, UCSF Liver Center, University of California, San Francisco, USA;3. National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Bldg. 10 Rm. 9B16, Bethesda, MD 20892, USA;1. Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy;2. Centro Cardiologico Monzino, IRCCS, Milan, Italy;3. Department of Surgery, Interventional Hepatology, Andrea Tortora Hospital, Pagani, Italy;4. Department of Surgery, Unit of General Surgery and Oncology, Andrea Tortora Hospital, Pagani, Italy;5. Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy |
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| Abstract: | - 1.1. The management of fifty-one patients with post-traumatic renal insufficiency included fluid restriction, attempts to maintain caloric intake, use of cation exchange resins, the treatment of anemia and electrolyte disturbances and the use of a Brigham-Kolff artificial kidney. Interval surgical care of these patients was of great importance not only because of the severity of their wounds but particularly because of the necessity for removing necrotic and infected tissue in patients with renal failure.
- 2.2. Dialysis with the artificial kidney was carried out seventy-two times in thirty-one patients of this series. It was effective in restoring clinical and chemical abnormalities toward normal and seemed to contribute to the reduction in mortality in this group of patients.
- 3.3. The mortality rate accompanying acute renal failure in military casualties in Korea was approximately 80 to 90 per cent, similar to the mortality rate during World War II. After establishment of a Renal Insufficiency Center and with the use of a Brigham-Kolff type artificial kidney, the over-all mortality rate in the fifty-one patients was 53 per cent.
- 4.4. The limiting factor in survival for most military patients with acute renal failure is the extent of the underlying wounds with attending infection and impaired wound healing.
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