Rhabdomyolysis, Earthquakes and Bombs

There seem to have been a lot of earthquakes and other natural disasters in the news over the last few years. It will come as a surprize to most people to learn that this leads to more cases of renal failure.

During World War II, it was found that people who were trapped under building rubble from the bombings seemed to develop a new disease, leading to acute kidney failure. Pressure from the rubble over a period of several hours lead to fluid loss into crush damaged areas of their limbs, and within 3-7 days many victims died. This was studied by Dr Eric Bywaters, of Hammersmith Hospital.

His studies showed that there was a brown pigment in the tubules of such victims, and some traces in their urine. This was shown to be myoglobin from the breakdown of cells in crushed muscles, and when it precipitated in the tubules, it lead to kidney failure. This occurs in cases of prolonged crush injuries, such as are also seen in earthquake victims. Indeed, anything that can destroy muscle tissue can lead to this problem. Treatment for shock and fluid replacement, via saline solutions, was recommended in 1942, and is still used today as the standard treatment. The fluid treatment tends to flush the myoglobin out of the kidneys before it can do too much damage.

The new disease is now known as Rhabdomyolysis, and occurs in earthquake and bomb blast victims. (Although there are a few other causes as well.) Around 15% of those with rhabdomyolysis are likely to suffer acute renal failure, and it became a widely recognised problem for earthquake victims after the 1998 Spitak (Armenia) earthquake. Dialysis is one successful treatment for such cases.

After the war, Hammersmith Hospital obtained one of Kolff's early hemodialysis machines and became a centre for studying renal failure.

Diagnosis of Rhabdomyolysis

Diagnosis often starts from suspicions about crush injuries and lengthy periods of immobilisation. Potassium levels in the blood may be high along with low calcium levels, and urine analysis by a dipstick may detect blood. The most reliable test is creatin kinase levels in the blood as damaged muscles release this enzyme, leading to levels up to fives times higher than normal. The presence of high levels of creatin kinase can indicate a greater probablity of acute kidney failure.