LEVELS OF NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN IN 2 P ATIENTS WITH CRUSH SYNDROME AFTER A MUDSLIDE Cases of Note www.ajcconline.org AJCC AMERICAN JOURNAL OF CRITICAL CARE, September 2011, Volume 20, No.5 6 By Valentina Donato, MD, Alberto Noto, MD, Antonio Lacquaniti, MD, Davide Bolignano, MD, Antonio Versaci, MD, Antonio David, MD, Francesco Spinelli, MD, and Michele Buemi, MD Abstract Neutrophil gelatinase-associated lipocalin is one of the most promising biomarkers for the diagnosis of acute kidney injury. An increase in the level of neutrophil gelatinase-associated lipocalin is a good predictor of acute kidney injury and is associated with an increase in the serum level of creatinine. Two victims of a mudslide in Messina, Italy, initially had crush syndrome followed by development of acute kidney injury. The development of acute kidney injury is the second most common cause of death after large earthquakes and other natural disasters, but at the same time, crush-related acute kidney injury is one of the few life-threatening complications of crush injuries that can be reversed if diagnosed early and treated. In this case, measuring the level of neutrophil gelatinase-associated lipocalin enabled early diagnosis of acute kidney injury and anticipation of the changes in levels of conventional markers such as crea- tinine. (American Journal of Critical Care. 2011;20:000-000) C rush syndrome is a clinical condition characterized by severe ischemia and reperfusion, which is established as a result of slow and prolonged compression of skeletal muscle of 1 or more limbs and consequential injury of the kidneys and other organ system dysfunc- tion. It occurs most often in response to catastrophic environmental events such as earthquakes, ava- lanches, and floods, and it is the second most common cause of disaster-related death, being itself a major organizational problem in terms of management by health facilities. 1,2 Crush syndrome is not a new concept in Italy: in 1909, German physician Von Colmers defined it as a syndrome characterized by severe muscle damage and renal failure that was associated with the entrapment of bodies under the rubble of the earthquake that involved Messina, Italy. 3 Continued on page ?? Cases of Note features peer-reviewed case reports and case series that document clinically relevant findings from critical and high acuity care environ- ments. Cases that illuminate a clinical diagnosis or a management issue in the treatment of critically and acutely ill patients and include discussion of the patient’s experience with the illness or intervention are encouraged. Proposals for future Cases of Note articles may be e-mailed to ajcc@aacn.org. ©2011 American Association of Critical-Care Nurses doi: 10.4037/ajcc2011???