Crush recommendations: a step forward in disaster nephrology.

In a supplement of Nephrology Dialysis and Transplantation, appearing simultaneously with the present issue, recommendations for the prevention and treatment of crush syndrome are published [1]. This monograph contains 85 recommendations, 23 tables, 9 figures and 376 references. Prepared by a workgroup of nephrologists, intensivists, surgeons and logisticians, they emanated out of a joint effort of European Renal Best Practice (ERBP) [2] and the Renal Disaster Relief Task Force of the International Society of Nephrology (RDRTF/ISN). Crush is a condition which carries a high risk of morbidity and mortality [3, 4]. The number of earthquakes necessitating nephrologic intervention because of crush is steadily growing [5–11]. Next to poor quality of buildings and overpopulation in endangered areas, this evolution can also be attributed to improved rescue and higher awareness of the renal complications of crush, the latter being brought about in part by interventions of specific nephrologic intervention teams. RDRTF/ISN, the first nephrologic relief organization [12, 13], embedded its rescuers in specialized non-nephrologic teams (belonging to Médecins sans Frontières – MSF) enabling backing in areas where (para-)medical personnel lacks know-how, such as logistic support. In spite of many saved lives, the consecutive interventions also revealed several weaknesses open to improvement. First, the medical expertise of the few practiced renal rescuers could insufficiently be disseminated over the many individual medical professionals taking care of crush patients. This shortcoming applied to diffusion of knowledge to nephrologists, most of whom have low exposure to crush in everyday practice. In addition, however, it also concerned other specialists or generalists who have limited experience with Acute Kidney Injury (AKI). Second, the existence and contact coordinates of renal relief teams remained often unknown to other relief organizations or to local specialists who after earthquakes coincidentally got involved in treatment of crushed victims without being prepared. The crush recommendations which are commented in this editorial hopefully cope with these problems, forwarding a structured approach to treat crush and associated conditions.