Medical Aspects of Objectifying Torture Sequels Causing Acute Renal Failure: A Clinical Case Series

Abstract

Background: Acute renal failure (ARF) following physical torture represents a serious but underreported medical consequence of human rights violations. The pathophysiology primarily involves rhabdomyolysis leading to myoglobinuric acute kidney injury. Methods: We present a retrospective case series of ten patients with ARF following alleged physical torture, managed at the Nephrology Department of SIMS Hospital between July 2011 and August 2021. Clinical presentation, laboratory findings, treatment modalities, and outcomes were analyzed. Results: All patients were young males (age 18-28 years) who developed ARF 4-11 days after alleged torture involving beatings to buttocks, back, and limbs. Additional torture methods included electric shocks (n=2) and prolonged forced exercise (n=1). Clinical presentation included generalized weakness (100%), oligoanuria (90%), vomiting (80%), hypertension (60%), acidosis (100%), edema (60%), and altered mental status (40%). Laboratory findings confirmed established ARF (serum creatinine 668-1,997 μmol/L, serum urea 21.8-71.8 mmol/L) with evidence of rhabdomyolysis through elevated muscle enzymes and myoglobin casts in urine. Nine patients had oliguric ARF requiring dialysis. All patients recovered with appropriate management. Conclusions: Early recognition and aggressive management of torture-related ARF is crucial for optimal outcomes. Healthcare providers must maintain high clinical suspicion for rhabdomyolysis-induced ARF in victims of physical violence, particularly when presentation is delayed.