FURTHER OBSERVATIONS ON ACUTE-RENAL-FAILURE FOLLOWING PHYSICAL TORTURE

Thirty-four males aged 16-40 (mean 25) years in the period from August 1991 to February 1993 presented in acute renal failure (ARF), 3-14 (mean 5) days after they had been apprehended and allegedly tortured in Police interrogation centres in Kashmir. All were beaten involving muscles of the body, in addition 13 were beaten on soles, 11 were trampled over and 10 had received repeated electric shocks. Patients were studied in three groups: group I, those with evidence of only myoglobinuria (n = 21); group II, those with both myoglobinuria and haemoglobinuria (n = 10); and group III, those with evidence of only haemoglobinuria (n = 3). All had varying degrees of ecchymotic patches on the body and patients in groups II and III were beaten on soles had ecchymosis of soles. Hypertension was present in 11 and pulmonary oedema in five. Mean haemoglobin, BUN and serum creatinine were not significantly different in the three groups. Creatine phosphokinase in groups I, II and III were 985-7516 (1358 +/- 368), 917-5277 (1431 +/- 188), and 517-816 (772 +/- 69) and lactic dehydrogenase levels were 757-3727 (2191 +/- 56), 592-3454 (1923 +/- 164), and 446-958 (632 +/- 115) respectively. All the cases had metabolic acidosis, 20 had hyperkalaemia. Plasma haemoglobin was 11-48 (mean 26) mg/dl in group II and 26-56 (mean 35) mg/dl in group III. Urine test for haemoglobin was positive in seven cases in group II and two cases in group III. Pigment casts were present in 10, eight and two cases in groups I, II, and III respectively. Only those who were beaten on soles had evidence of haemoglobinuria. Twenty-nine cases recovered and five died. Both myoglobinuria and haemoglobinuria can cause ARF in such a setting and an early diagnosis is essential for management.