After jumping into the lake to save people twice, his creatinine level went through the roof. The reason was…

Recently, a female passenger took Master Cai's taxi to the lake and then jumped into the lake to commit suicide. Master Cai immediately jumped into the cold lake and rescued the woman to shore. Unexpectedly, the woman jumped into the lake again when Master Cai was not paying attention. At this time, Master Cai was exhausted, but he jumped into the water again and pushed the woman to shore.

After that, Master Cai no longer had the strength to swim to shore until the police came and rescued him. As a result, Master Cai was diagnosed with acute renal failure the next day. The doctor speculated that the acute renal failure was probably related to his diving to save people.

When I saw this news, the first thing I thought of was "acute kidney injury caused by exhausting swimming in low-temperature water."

Swimming in cold water will induce high stress in the body due to factors such as fatigue, cold, cold water immersion, and emotional anxiety. This includes anti-fatigue stress and cold stress[1]. After immersion in cold water, the patient's body temperature will be too low, dropping below 35 °C. Some complications may occur, including pulmonary insufficiency, cardiovascular disease, coagulation dysfunction, central nervous system dysfunction, acute kidney injury, etc., among which acute kidney injury usually manifests as acute tubular necrosis[2]. Acute kidney injury is usually manifested in clinical diagnosis as low back pain, edema, significantly reduced urine volume, proteinuria, significantly reduced serum creatinine and serum urea nitrogen, and percussion pain in both kidneys. Renal biopsy mainly shows tubular and interstitial changes, no obvious changes in glomeruli, and diffuse and severe intimal thickening blocking the arterial lumen[2].

Acute kidney injury caused by hypothermic exhaustive swimming is mainly due to renal vasoconstriction and ischemia.

Immersion in water can cause systemic blood redistribution in normal people, resulting in relative central hypovolemia. There is evidence that immersion in water can induce elevated levels of natriuretic hormones and diuretic hormones and increased cardiac output in normal subjects. After leaving the water, cardiac output suddenly decreases, which may lead to renal hypoperfusion and ischemia in immersed patients. At the same time, low temperature can also accelerate renal vasoconstriction and ischemia, ultimately leading to acute tubular ischemic necrosis.

In addition, the occurrence of acute kidney injury is related to the increase of endothelin levels and thickening of renal vascular intimal smooth muscle caused by stress. Studies have shown that the concentration of endothelin in plasma and renal tissue of patients with acute kidney injury is significantly increased, and endothelin receptor antagonists can improve experimental ischemic acute kidney injury in rats. Endothelin promotes the synthesis of vascular smooth muscle cells in a dose-dependent manner and can affect the proliferation activity of intimal smooth muscle cells in patients with hypertension. Therefore, the increase of endothelin may be closely related to the thickening of renal vascular intimal smooth muscle, and it can also cause renal hypoperfusion and ischemia, ultimately causing renal injury.

The treatment of acute kidney injury caused by hypothermic water exhaustion swimming is mainly hemodialysis.

First, give the patient heat therapy immediately, take off all wet and cold clothes and dry them with a dry towel, move him to a quiet single room and cover him with a thick quilt.

Secondly, soak and massage the limbs with warm water at 38-40 ℃, apply wet compresses to the trunk with a hot towel, and then perform warm intravenous infusion therapy.

Finally, hemodialysis treatment was performed with a blood flow of 220 ml/min and the dialysate heated to 38°C. The patient underwent hemodialysis once a day in the first 3 days after admission. After symptoms improved, the hemodialysis could be changed to once every other day.

Patients with acute kidney injury caused by exhausting swimming in low-temperature water also need post-treatment care. We need to do a good job of ideological work with patients, relieve their mental burden, and eliminate their fear. Afterwards, patients should rest in bed to reduce the burden on their kidneys. Before their kidney function returns to normal, they should not eat high-potassium foods such as watermelons and bananas.

When admitted to the hospital, most patients are in a state of stress and need to prevent stress ulcers. They can be given appropriate acid suppression and stomach protection treatments and nutritional support. In the later stages, they can gradually increase their protein intake, drink more water, and eat more high-calorie, potassium-rich foods [3].

Acute kidney injury caused by exhausting swimming in cold water is rare. If such patients are encountered clinically, the possibility of this disease must be considered. Timely symptomatic treatment and correct care are very important for recovery from the disease.

References:

[1] Luo Yizhou, Fu Jihua, Liao Hui, et al. Effects of low-temperature seawater exhaustive swimming-induced stress on blood cells and liver and kidney function in rats [J]. Journal of South China Military Medical Science, 2007(04):31-32.

[2] Yoshitomi Y, Kojima S, Ogi M, Kuramochi M. Acute renal failure in accidental hypothermia of cold water immersion. Am J Kidney Dis. 1998 May;31(5):856-9.

[3] Jiang Fang. Nursing care for patients with acute kidney injury caused by exhaustive swimming in low-temperature water[J]. Journal of Nursing, 2011, 18(23): 44-46.