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Vol. 27, Art. 23 (pp. 555-576)    |    2026       

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Prediction and prevention of acute kidney injury in the wounded and injured with combat surgical trauma

Marukhov A.V.
Federal State Budgetary Military Educational Institution of Higher Education "S.M. Kirov Military Medical Academy" of the Ministry of Defense of the Russian Federation

Brief summary

The high incidence of severe combined and multiple injuries, along with the complex medical and tactical situation inherent in modern military conflict, often leads to significant blood loss and difficulties in ensuring the evacuation of the wounded and injured. This predisposes to a high prevalence of hypovolemia and its significant role in the development of acute kidney injury, which occurs in 12.5-34.3% of patients with combat surgical trauma. This problem requires the use of simple methods, accessible at the stages of providing qualified medical care, for identifying and monitoring the severity of volemic status and renal hemodynamic disturbances for their diagnosis and correction. Such methods include the determination of ultrasound parameters of inferior vena cava collapsibility and the renal resistive index during dynamic observation of severely wounded patients in the early stages of medical evacuation. Objective: To study the effectiveness of using early ultrasound diagnostics and monitoring of volemic status and renal hemodynamic disturbances in the wounded and injured during modern armed conflict for the prediction and prevention of acute kidney injury. Materials and Methods. The article describes data obtained from a prospective observational study aimed at investigating the role of identifying and correcting volemic status and renal hemodynamic disturbances in the treatment of the wounded and injured at the stage of providing qualified medical care. The results of diagnostics and intensive therapy of 164 servicemen with combat injuries sustained during active duty in a modern military conflict, who were treated in a separate medical battalion stationed in a border region of the Russian Federation, are presented. It is shown that monitoring ultrasound parameters of inferior vena cava collapsibility and the renal resistive index at the early stage of medical care improves diagnostic and treatment outcomes for the wounded and injured. Achieving normal values of inferior vena cava collapsibility and renal resistive index during intensive therapy was associated with a significant reduction in the subsequent incidence of acute kidney injury by 20.3% (p=0.026) and 27% (p=0.0002), respectively. ROC analysis revealed an optimal renal resistive index threshold of 0.73, which had the most pronounced prognostic value for the development of acute kidney injury (sensitivity - 82.1%, specificity - 92.1%, accuracy - 89.9%). Conclusion. Incorporating the studied parameters into protocols for managing the wounded and injured at the stage of qualified medical care appears to be an effective method for improving clinical outcomes by reducing the incidence of acute kidney injury, which complicates the course of traumatic illness.


Key words

wounded and injured; hypovolemia; inferior vena cava; acute blood loss; renal resistive index

Reference list

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