Pediatric kidney care experience after the 2023 Türkiye earthquake.

Two earthquakes on 6 February 2023 destroyed 10 cities in Türkiye. We report our experience with pediatric victims during these catastrophes, with a focus on crush syndrome related-acute kidney injury (Crush-AKI) and death. Web-based software was prepared. Patient demographics, time under rubble (TUR), admission laboratory data, dialysis, and kidney and overall outcomes were recorded. A total of 903 injured children (median age 11.62 years) were evaluated. Mean TUR was 13 h (interquartile range 32.5, max 240 h). Thirty-one of 32 patients with a TUR of >120 h survived. The patient who was rescued after 10 days survived. Two-thirds of the patients were given 50 mEq/L sodium bicarbonate in 0.45% sodium chloride solution on admission day. Fifty-eight percent of patients were given intravenous fluid (IVF) at a volume of 2000-3000 mL/m2 body surface area (BSA), 40% at 3000-4000 mL/m2 BSA and only 2% at >4000 mL/m2 BSA. A total of 425 patients had surgeries, and 48 suffered from major bleeding. Amputations were recorded in 96 patients. Eighty-two and 66 patients required ventilator and inotropic support, respectively. Crush-AKI developed in 314 patients (36% of all patients). In all, 189 patients were dialyzed. Age >15 years, creatine phosphokinase (CK) ≥20 950 U/L, TUR ≥10 h and the first-day IVF volume <3000-4000 mL/m2 BSA were associated with Crush-AKI development. Twenty-two deaths were recorded, 20 of 22 occurring in patients with Crush-AKI and within the first 4 days of admission. All patients admitted after 7 days survived. These are the most extensive pediatric kidney disaster data obtained after an earthquake. Serum CK level was significantly associated with Crush-AKI at the levels of >20 950 U/L, but not with death. Adolescent age and initial IVF of less than 3000-4000 mL/m2 BSA were also associated with Crush-AKI. Given that mildly injured victims can survive longer periods in the disaster field, we suggest uninterrupted rescue activity for at least 10 days.

Bakkaloğlu SA ，Delibaş A ，Sürmeli Döven S ，Taner S ，Yavuz S ，Erfidan G ，Danacı Vatansever E ，Aynacı F ，Yilmaz K ，Taşdemir M ，Akacı O ，Akıncı N ，Güven S ，Çiçek N ，Dursun I ，Keleşoğlu E ，Sancaktar M ，Alaygut D ，Saygılı S ，Yavaşcan Ö ，Yılmaz A ，Gülleroğlu K ，Ertan P ，Demir BK ，Poyrazoğlu H ，Pınarbaşı S ，Gençler A ，Baştuğ F ，Günay N ，Çeleğen K ，Noyan A ，Parmaksız G ，Avcı B ，Çaycı FŞ ，Bayrakçı U ，Özlü SG ，Aksoy ÖY ，Yel S ，İnal GA ，Köse S ，Bayazıt AK ，Atmış B ，Sarıbaş E ，Çağlı Ç ，Tabel Y ，Elmas AT ，Zırhlı Selçuk Ş ，Demircioğlu Kılıç B ，Akbalık Kara M ，Büyükçelik M ，Balat A ，Durucu Tiryaki B ，Erdoğdu B ，Aksu B ，Mahmudova G ，Dursun H ，Candan C ，Göknar N ，Mutlubaş F ，Çamlar SA ，Başaran C ，Akbulut BB ，Düzova A ，Gülhan B ，Oruç Ç ，Peru H ，Alpay H ，Türkkan ÖN ，Gülmez R ，Çelakıl M ，Doğan K ，Bilge I ，Pehlivanoğlu C ，Büyükkaragöz B ，Leventoğlu E ，Alpman N ，Zeybek C ，Tülpar S ，Çiçek Gülşan RY ，Kara A ，Gürgöze MK ，Akyol Önder EN ，Özdemir Atikel Y ，Pul S ，Sönmez F ，Yıldız G ，Akman S ，Elmacı M ，Küçük N ，Yüksel S ，Kavaz A ，Nalçacıoğlu H ，Alparslan C ，Dinçel N ，Elhan AH ，Sever L ... -  《-》

Kidney Replacement Therapies and Outcomes in Children With Crush Syndrome-Associated Kidney Injury.

Demirkol D ，Besci T ，Havan M ，Karacanoglu D ，Kihtir HS ，Yildizdas D ，Duyu M ，Özel A ，Kocaoglu DPY ，Gökay N ，Durak F ，Misirlioglu M ，Kilinç MA ，Sincar S ，Varol F ，Köker A ，Dalkiran T ，Yaman A ，Akçay N ，Göncü S ，Talip M ，Akkuzu E ，Uçmak H ，Kendirli T ，Barlas Koçoglu Ü ，Tufan E ，Çebisli E ，Ekinci F ，Kutlu NO ，Kocaoglu Ç ，Koç G ，Alakayav M ，Çolak M ，Önder C ，Güvenç KB ，Ülgen Tekerek N ，Dursun O ，Aygüler E ，Gençay AG ，Bayrakçi B ... -  《-》

Epidemiological analysis of the victıms wıth crush syndrome in earthquakes of southeastern Turkey.

Ozturk I ，Gungor O ，Ozturk S ，Olmaz R ，Keskin AJG ，Kocyigit I ，Sipahioglu MH ，Dede F ，Ulu S ，Turgutalp K ，Torun D ，Sahutoglu T ，Erdur FM ，Altunoren O ，Danis R ，Yildiz G ，Gurel A ，Horoz M ，Kucuksu M ，Karakose S ，Yildirim T ，Altiparmak MR ，Ayli MD ，Tugcu M ，Eren Z ，Eroglu E ，Yavuz YC ，Akcali E ，Sit D ，Polat M ，Yildirim S ，Alagoz S ，Bek SG ，Pembegul I ，Karaaslan T ，Keles M ，Sari F ，Yilmaz U ，Gorgulu N ，Sahin G ，Aydin Z ，Yadigar S ，Ulutas O ，Selcuk NY ，Ayar Y ，Turgut D ，Oto OA ，Koc M ，Yıldız A ，Tuglular S ，Sever MS ... -  《-》

Pediatric crush-related acute kidney injury and risk factors: a single center experience.

Crush injury, the most important trauma complication encountered in earthquake victims, occurs as a result of prolonged compression of muscle mass. Crush syndrome, resulting from crush injury, and acute kidney injury (AKI) are the most common causes of in-hospital deaths after earthquakes. The aim of this study is to convey our experience after the devastating Turkey-Syria earthquake and to identify the risk factors of crush syndrome and crush-related AKI. Of the 1134 children admitted to the emergency department, 265 with crush injury were included the study. Demographic information, laboratory and clinical data of the patients were retrospectively analyzed. Mean age of the patients was 10.3 ± 4.9 years (134 females and 131 males). The median time spent under the rubble was 20 h. Crush syndrome developed in 135 (50.9%). Patients with crush syndrome were older and had higher body weight, respectively (p = 0.014, p = 0.044). Acute kidney injury was present in 157 (59.2%) patients. Thirty-two patients (12.1%) received kidney replacement therapy (KRT). The risk factors for the development of AKI Stage 3 were crush syndrome, abdominal trauma, and age. This disaster taught us the importance of establishing in advance a national emergency disaster plan. Older pediatric earthquake victims with multiple trauma and severe crush syndrome should be closely followed-up for development of AKI and, if necessary, started on dialysis. Timely access to medical care, early fluid resuscitation, and effective use of dialysis treatment are essential.

Taner S ，Ozdemir U ，Kandemir Gulmez T ，Güven S ，Cicek N ，Kelesoglu E ，Arslan I ，Celik U ... -  《-》

A new score predicting renal replacement therapy in patients with crush injuries: Analysis of a major earthquake.

It is important to predict which patients may require renal replacement therapy (RRT) at the time of initial presentation after crush injuries. There is limited data in the literature examining the predictors of RRT. This study was conducted by evaluating 2232 patients who presented to our hospital following two major earthquakes of magnitudes 7.6 and 7.7 Mw that occurred in Kahramanmaras, Turkey, on February 6, 2023. A total of 314 patients who were hospitalized upon being rescued from the rubble and had a creatine kinase (CK) level above 1000 U/L were included in the final analysis. Factors predicting the need for RRT were investigated, and a dialysis score was developed for this prediction. Of the 314 patients included in the study, 95 (30.2 %) developed acute kidney injury (AKI). RRT was performed on 68 (21.6 %) patients. The optimal cut-off value of CK for the prediction of AKI was 23,000 U/L. Multivariate analysis revealed that factors predicting RRT were the number of traumatized sides (odds ratio [OR]: 2.2, 95 % confidence interval [CI]: 1.09-4.39, p = 0.026), albumin (OR:0.11, 95 % CI: 0.04-0.32, p < 0.001), and CK (OR: 1.00, 95 % CI 1.00-1.00, p < 0.001). A dialysis score was developed ranging from 0 to 7 based on the number of traumatized sides, albumin, and CK. The area under the curve (AUC) of the dialysis score in receiver operating characteristic analysis was 0.974. A dialysis score of 4 or higher had a sensitivity of 97.1 % and a specificity of 89.4 % for predicting the need for RRT. The dialysis score predicts the need for RRT quite well. The simplicity of use and high sensitivity and specificity of this score in earthquake-related crush injuries will greatly facilitate clinicians in patient triage and follow-up.

Comoglu M ，Acehan F ，Inan O ，Demir BF ，Yılmaz Y ，Sahiner ES ... -  《-》