How are renal injuries managed in heat stroke?

Updated: Nov 06, 2018
  • Author: Robert S Helman, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Answer

AKI may occur because of direct thermal injury of the kidney, myoglobinuria, hypotension, and/or shock (acute tubular necrosis). Early manifestations of AKI include oliguria, low-grade proteinuria, and granular casts.

AKI initially is treated with intravenous fluids, diuretics, and correction of associated acid-base and electrolyte abnormalities. In the setting of rhabdomyolysis, mannitol may be the diuretic of choice because it does not interfere with the acid-base status of the urine, and it may have antioxidant activity. Furosemide may cause tubular acidosis and, therefore, may promote myoglobin deposition within the renal tubules. Once renal failure has set in, hemodialysis is the most effective therapy.


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