ACUTE-RENAL-FAILURE IN EARTHQUAKE VICTIMS IN IRAN - EPIDEMIOLOGY AND MANAGEMENT

The 1990 Iran earthquake affected two provinces with a population of 2 .3 million, resulting in at least 13888 deaths and 43390 injured, and in 33615 hospitalizations. Overall mortality among hospitalized patien ts was 0.17%. Acute renal failure (ARF) requiring dialysis support was diagnosed in 156 patients nationwide, with a mortality rate of 14%. T hree teaching hospitals of the Tehran University of Medical Sciences a dmitted 495 patients, with overall mortality of 7.5%. Of these, 30 (6% ) required dialysis support, with mortality of 40%, accounting for one -third of all deaths. On admission, patients with ARF were more severe ly injured, with significantly higher incidence of multiple trauma, pe ripheral nerve damage, elevated plasma concentrations of muscle enzyme s, potassium and phosphate, and abnormal urinalysis. In one of the thr ee hospitals, patients were treated with a standardized hydration prot ocol coupled with a cautious approach to fasciotomy. The incidence of ARF, mortality associated with ARF, and fasciotomy were lower in this group. Our limited experience suggests that this standardized approach to prevention and treatment of ARF in earthquake victims may be helpf ul.