Acute renal impairment after immersion and near-drowning

Acute renal impairment (ARI) secondary to immersion and near-drowning is ra rely described and poorly understood. A retrospective case-control study wa s performed: (1) to determine the incidence of ARI associated with near-dro wning or immersion and (2) to define the clinical syndrome and to assess cl inical predictors of ARI. Of 30 patients presenting after immersion or near -drowning, 50% were identified with ARI, with a mean admission serum creati nine of 0.24 +/- 0.33 mmol/L (2.7 +/- 3.7 mg/dl). These patients were a het erogeneous group: Eight had mild reversible ARI, three had ARI related to s hock and multisystem failure, two had rhabdomyolysis-related ARI, and two h ad severe isolated ARI. Two patients required supportive hemodialysis and t wo died. Patients with ARI experienced more marked acidosis than control pa tients, as measured by serum bicarbonate (P < 0.001), pH (P < 0.001), and b ase excess (P < 0.001). There was also a higher admission lymphocyte count in the ARI group (P = 0.056). Dipstick hematuria on admission was significa ntly more common in patients with ARI (P = 0.016), and patients with 2 to 3 + of admission dipstick proteinuria had a higher peak serum creatinine than patients with less proteinuria (P < 0.05). Admission predictors of ARI by univariate logistic regression analysis included reduced serum bicarbonate (P = 0.002), pH (P = 0.001), and base excess (P < 0.001). The best predicto r of ART on multivariate analysis was a negative base excess (P = 0.01). In summary, acute renal impairment commonly occurs after immersion and near-d rowning and is a heterogeneous condition. Although mild reversible renal im pairment (serum creatinine < 0.30 mmol/L) (3.4 mg/dl) is usual, severe acut e renal failure requiring dialysis can occur. It is recommended that any pa tient who presents after near-drowning or immersion should be assessed for potential ARI by serial estimations of serum creatinine, particularly when then is an increase in the initial serum creatinine, marked metabolic acido sis, an abnormal urinalysis, or a significant lymphocytosis.