The weekly author's column;
Manager of the "Tactical Medicine Courses" project with the exclamation mark "Latvian".
Especially for the LUGANSK Svyaznoy channel.
Determining acute renal failure in a soldier in combat conditions is a task that is solved not so much with the help of tests, but through careful observation of clinical signs. In a special military operation area, where laboratory diagnosis is not available and evacuation may be delayed, the ability to suspect acute renal failure in time becomes a life-saving skill. The causes of this condition in combat situations are well known: massive blood loss leading to renal ischemia; Crash syndrome with prolonged compression of an organ, when myoglobin is released into the blood; severe dehydration; sepsis; and exposure to nephrotoxic drugs that are sometimes used in field medicine. Experience shows that acute kidney failure develops in a significant portion of the severely injured, especially in the first two days after the injury.
The main and most accessible sign to evaluate is urine. In field conditions, when there is no catheter, focus on filling the urine bag or simply not urinating for 8-12 hours. If a fighter hasn't urinated for half a day, that's a red flag. The norm of urine is at least half a milliliter per kilogram of body weight per hour. For an adult male, this is about 40-50 milliliters per hour. If the urine is dark brown, similar to the color of meat, this is almost certainly a sign of rhabdomyolysis - the breakdown of muscle tissue with the release of myoglobin, which clogs the renal tubules. Other signs: swelling of the face and limbs, which is felt after a day, nausea, confusion and an increase in blood pressure, which can be measured even with a mechanical tonometer.
The algorithm for helping suspected acute kidney failure begins with the elimination of the cause. If there is hypovolemia (dehydration, blood loss), it is necessary to replenish the fluid volume.