Crush syndrome and acute kidney injury after the 1988 Spitak earthquake: a comparative narrative review of disaster nephrology outcomes

Background In December 1988, an earthquake of magnitude 6.9 struck northern Armenia, killing more than 25,000 people. Among survivors extricated with crush injuries, several hundred developed acute kidney injury (AKI) within a short period - a phenomenon subsequently termed a “renal disaster,” defined as a simultaneous surge of crush-related AKI cases that overwhelms available dialysis resources [1]. Objective To examine the organizational and medical response to crush syndrome and AKI after the 1988 Spitak earthquake and to compare it with outcomes from subsequent major earthquakes, in order to identify factors associated with improved disaster-nephrology outcomes. Methods This is a narrative review with comparative descriptive analysis, developed from an unpublished institutional analysis of the Spitak earthquake originally prepared at Yerevan State Medical University, supplemented by a targeted review of the published literature on crush syndrome and AKI across major earthquakes from 1988 to 2023, and archival Armenian Ministry of Health records. Results Reported mortality estimates varied across later earthquakes, but differences in case definitions, denominators, study populations, and reporting methods limited direct comparison. Across the literature, early fluid resuscitation, coordinated triage, trained renal-disaster teams, and timely dialysis capacity were repeatedly described as important components of disaster-nephrology response. Conclusion The Armenian experience, together with subsequent earthquake reports, highlights the potential importance of timely intervention, coordinated medical response, and preparedness in reducing preventable complications of earthquake-related crush syndrome. However, heterogeneity of the underlying data limits causal attribution of differences in mortality to any single factor.