침수 후 발생한 급성 신손상 1예

Abstract

Acute renal failure (ARF) secondary to immersion and near-drowning has rarely been described and it is poorly understood. ARF associated with immersion and near-drowning might be involved with systemic tissue hypoxia, hypovolemia and hypothermia. Some reports have shown that rhabdomyolysis could be involved. We report here on a 52 year old seaman who developed ARF after cold sea-water immersion. He had been swimming for one hour in cold sea-water because his ship became stuck on a rock. After 2 days, his serum creatinine level was increased to 7.8 mg/dL, and pulmonary edema was developed. The serum myoglobin level was 495.1 ng/mL. He was diagnosed as oliguric ARF and treated with hemodialysis. Thereafter, renal function was gradually recovered. We presumed that hypothermia-induced vasoconstriction, hypovolemia and rhabdomyolysis were involved in ARF in the patient. It should be considered that cold sea-water immersion for a long time could evoke ARF in healthy men.