Acute Kidney Injury Following Near-Drowning: Narrative Review

Acute renal injury (AKI) due to near-drowning occurs as a relatively common complication and can cause irreversible damage to the kidneys. These injuries usually occur in the early stages of drowning, are self-limiting, and renal replacement therapy is rarely needed. The number of studies conducted in this field is very limited and comprehensive information is not available to investigate and understand the prevalence and mechanism of its complication. However, some literature suggests that acute tubular necrosis during shock, hypoxia and myoglobinuria following drowning may be a major cause of AKI. In a retrospective study on 30 near-drowned patients in 1999, about 50% of patients developed submersion-induced AKI with heterogeneous mechanisms including rhabdomyolysis, multi-organ failure, and shock. Between 2000 and 2017, in a retrospective cohort, out of 95 patients who were taken to hospital with a diagnosis of drowning, 42 (43.3%) developed AKI, 17 (18%) of whom were in the second and third stages of the injury. Also, one patient underwent renal replacement therapy.The evidence indicates a significant prevalence of AKI in people who have survived by drowning. Serial monitoring of creatinine levels and training patients of danger signs after discharge is recommended even in asymptomatic patients.