Predicting the risk of acute kidney injury in earthquake victims

Acute kidney injury (AKI), mainly as a result of crush syndrome, is the second most common cause of death in large earthquakes. It is well known that AKI is preventable with early management (particularly with fluid therapy), but a means of determining which patients are at risk is needed. This Practice Point commentary discusses Najafi et al.'s analysis of data from an earthquake in Iran in December 2003, from which they propose two decision rules that use routine data to predict development of AKI. The first rule uses serum levels of creatinine, lactate dehydrogenase and uric acid on day 1 to predict the risk of AKI. The second rule predicts serum creatinine level on day 3 using serum creatine phosphokinase, lactate dehydrogenase, potassium and uric acid level. Although further investigation in a larger number of patients and in different disaster situations is needed to confirm the validity of these simple rules, they might be very useful, particularly for non-nephrologists and rescue staff, for the early identification of disaster victims at high risk of AKI.