Features of Acute Kidney Injury in Combat Casualties During Modern Armed Conflict

Abstract

Background: In modern armed conflicts, wounds and injuries of various etiologies have become an inherent component of combat operations. The main research directions concerning such injuries are aimed at identifying causal relationships between the nature of the trauma, the features of its acute phase, and the development of complications, including acute kidney injury. A review of the literature revealed sufficient information on the leading pathophysiological mechanisms underlying the development of acute kidney injury. However, early diagnostic methods for this complication have not yet been developed, which prompted the conduct of this study. AIM: To identify factors influencing the risk of acute kidney injury in combat casualties and to determine the frequency of the leading pathogenetic mechanisms in the early phase of traumatic disease. MATERIALS AND METHODS: A prospective analysis was conducted involving 104 patients with wounds who were admitted to the 1602 Military Clinical Hospital of the Ministry of Defense of the Russian Federation (Rostov-on-Don) between January and March 2024. Upon admission to the multidisciplinary hospital, the severity of patients’ conditions was assessed using the admission condition scale developed by the Department of military field surgery. Based on the assessment results, patients were divided into three categories: 1—patients with decompensated traumatic disease (score 34; 17 patients, 16.4%); 2—patients with subcompensated traumatic disease (score 25–34; 49 patients, 47.1%); 3—patients with compensated traumatic disease (score ≤24; 38 patients, 36.5% of the total). Assessment included medical history, evaluation of vital signs, 24-hour urine output measurement, complete blood count, urinalysis, serial blood chemical analysis (three measurements), electrocardiography, and chest X-ray. Statistical processing of the experimental data was performed using SPSS Statistics 27 (IBM). RESULTS: As a result of the study, diagnostic factors influencing the risk of this complication in the early phase of traumatic disease were identified, including hemoglobin, hematocrit, creatinine, estimated glomerular filtration rate, urea, 24-hour urine output, and potassium levels; their statistical significance was confirmed. Based on the intergroup analysis of the obtained data, no cases of acute kidney injury were recorded in the group of patients with compensated traumatic disease. The incidence of acute kidney injury was 82.3% among patients with decompensated traumatic disease and 24.5% among those with subcompensated disease. Of the 26 patients diagnosed with acute kidney injury, 12 (46.1%) presented with a non-oliguric form. The leading pathogenetic mechanisms were prerenal acute kidney injury due to hypovolemia (69.2%), renal injury associated with rhabdomyolysis (23%), and metabolic acidosis (8.3%). CONCLUSION: The results obtained in this study indicate a high incidence of acute kidney injury (up to 25%) among patients with wounds and injuries in modern armed conflict, with prerenal mechanisms being the predominant pathogenetic variant. Due to the limited diagnostic value of standard methods, particularly in patients presenting with the non-oliguric form, it is essential to develop a comprehensive approach to the diagnosis of acute kidney injury in wounded and injured individuals. This approach should incorporate modern laboratory biomarkers and be applied during the early phase of traumatic disease.