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Gao H, Xiang Q, Li J, Yu M, Lan Y, Ba J, Liu Y, Tian H. Clinical analysis of the serum muscle enzyme spectrum of patients with newly diagnosed Sheehan's syndrome. Medicine (Baltimore) 2022; 101:e30834. [PMID: 36181079 PMCID: PMC9524868 DOI: 10.1097/md.0000000000030834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
We investigated the factors associated with serum muscle enzyme elevation in patients with Sheehan's syndrome. A total of 48 patients who were newly diagnosed with Sheehan's syndrome were included and divided into 3 groups: Group 1, creatine kinase (CK) ≥ 1000 U/L; Group 2, 140 < CK < 1000 U/L; and Group 3, CK ≤ 140 U/L. Differences in serum muscle enzymes, serum electrolytes, blood glucose and hormones were compared among the 3 groups. A Spearman correlation analysis and multiple linear regression analysis were performed on serum muscle enzymes and the other variables. Four patients in Group 1 underwent electromyography. Fourteen, 26 and 8 patients were divided into Group 1, Group 2, and Group 3, respectively. The levels of plasma osmolality, serum sodium, free triiodothyronine (FT3) and free thyroxine (FT4) in Group 1 were lower than those in Group 3 at admission (P < .05). There were significant differences in CK, CK-MB, aspartate aminotransferase, lactate dehydrogenase, and alpha-hydroxybutyrate dehydrogenase among the three groups (P < .05). CK was correlated with serum sodium (r = -0.642, P < .001), serum potassium (r = -0.29, P = .046), plasma osmolality (r = -0.65, P < .001), FT3 (r = -0.363, P = .012), and FT4 (r = -0.450, P = .002). Moreover, creatine kinase isoenzyme-MB (CK-MB) was correlated with serum sodium (r = -0.464, P = .001) and plasma osmolality (r = -0.483, P < .001). The multiple linear regression showed that serum sodium was independently and negatively correlated with CK (r = -0.352, P = .021). The electromyogram results supported the existence of myogenic injury. Sheehan's syndrome is prone to be complicated by nontraumatic rhabdomyolysis, with both a chronic course and acute exacerbation. Serum muscle enzymes should be routinely measured. For patients with CK levels > 1000 U/L, a CK-MB/CK ratio < 6% can be a simple indicator to differentiate rhabdomyolysis from acute myocardial infarction. Abnormal serum muscle enzymes observed in Sheehan's syndrome may be associated with hypothyroidism and with hyponatremia in particular.
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Affiliation(s)
- Hongjiao Gao
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
- Department of Endocrinology, the Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, China
| | - Qiao Xiang
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
| | - Jindie Li
- Department of Endocrinology, the Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, China
| | - Meng Yu
- Department of Endocrinology, the Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, China
| | - Yalin Lan
- Department of Endocrinology, the Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, China
| | - Junqiang Ba
- Department of Endocrinology, the Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, China
| | - Yan Liu
- Department of Laboratory Medicine, the Third Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Haoming Tian
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
- *Correspondence: Haoming Tian, West China Hospital of Sichuan University, Chengdu 610041, China (e-mail: )
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Hebert JF, Burfeind KG, Malinoski D, Hutchens MP. Molecular Mechanisms of Rhabdomyolysis-Induced Kidney Injury: From Bench to Bedside. Kidney Int Rep 2022; 8:17-29. [PMID: 36644345 PMCID: PMC9831947 DOI: 10.1016/j.ekir.2022.09.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 01/18/2023] Open
Abstract
Rhabdomyolysis-induced acute kidney injury (RIAKI) occurs following damage to the muscular sarcolemma sheath, resulting in the leakage of myoglobin and other metabolites that cause kidney damage. Currently, the sole recommended clinical treatment for RIAKI is aggressive fluid resuscitation, but other potential therapies, including pretreatments for those at risk for developing RIAKI, are under investigation. This review outlines the mechanisms and clinical significance of RIAKI, investigational treatments and their specific targets, and the status of ongoing research trials.
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Affiliation(s)
- Jessica F. Hebert
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon, USA,Correspondence: Jessica F. Hebert, Oregon Health and Science University, Department of Anesthesiology and Perioperative Medicine, Portland, Oregon, USA.
| | - Kevin G. Burfeind
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Darren Malinoski
- Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA,Operative Care Division, Portland Veterans Administration Medical Center, Portland, Oregon, USA
| | - Michael P. Hutchens
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon, USA,Operative Care Division, Portland Veterans Administration Medical Center, Portland, Oregon, USA
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Tan MS, Gomez-Lumbreras A, Villa-Zapata L, Malone DC. Colchicine and macrolides: a cohort study of the risk of adverse outcomes associated with concomitant exposure. Rheumatol Int 2022; 42:2253-2259. [PMID: 36104598 PMCID: PMC9473467 DOI: 10.1007/s00296-022-05201-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/27/2022] [Indexed: 11/25/2022]
Abstract
Colchicine is increasingly used as the number of potential indications expands. However, it also has a narrow therapeutic index that is associated with bothersome to severe side effects. When concomitantly use with medications inhibiting its metabolism, higher plasma levels will result and increase likelihood of colchicine toxicity. We conducted a cohort study using electronic health records comparing encounters with colchicine plus a macrolide and colchicine with an antibiotic non-macrolide. We assessed the relationship between the two groups using adjusted multivariate logistic regression models and the risk of rhabdomyolysis, pancytopenia, muscular weakness, heart failure, acute hepatic failure and death. 12670 patients on colchicine plus an antibiotic non-macrolide were compared to 2199 patients exposed to colchicine plus a macrolide. Patients exposed to colchicine and a macrolide were majority men (n = 1329, 60.4%) and white (n = 1485, 67.5%) in their late sixties (mean age in years 68.4, SD 15.6). Heart failure was more frequent in the colchicine plus a macrolide cohort (n = 402, 18.3%) vs the colchicine non-macrolide one (n = 1153, 9.1%) (p < 0.0001) and also had a higher mortality rate [(85 (3.87%) vs 289 (2.28%), p < 0.0001 macrolides vs non-macrolides cohorts, respectively]. When the sample was limited to individuals exposed to either clarithromycin or erythromycin and colchicine, the adjusted OR for acute hepatic failure was 2.47 (95% CI 1.04–5.91) and 2.06 for death (95% CI 1.07–3.97). There is a significant increase in the risk of hepatic failure and mortality when colchicine is concomitantly administered with a macrolide. Colchicine should not be used concomitantly with these antibiotics or should be temporarily discontinued to avoid toxic levels of colchicine.
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Rashidi A, Fritz J. Sports Imaging of COVID-19: A Multi-Organ System Review of Indications and Imaging Findings. Sports Health 2022; 14:618-631. [PMID: 35746891 PMCID: PMC9460088 DOI: 10.1177/19417381221106448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in December 2019 in Wuhan, China. Although coronavirus disease-19 (COVID-19) affects every population group, the sports community and athletes require special consideration of the effects on cardiovascular, musculoskeletal, neurologic, and respiratory systems. A comprehensive understanding of imaging indications, findings, and features of COVID-19 supports appropriate imaging utilization and effective patient management and treatment. PURPOSE To review the spectrum of sports imaging in COVID-19 infection, organ system manifestations, vaccine effects, and complications in recreational and competitive athletes. STUDY DESIGN Narrative review. LEVEL OF EVIDENCE Levels 4 and 5. METHODS Based on a PubMed database search, studies describing the imaging findings of COVID-19 infection, organ system manifestations, vaccine effects, and complications in recreational and competitive athletes were included. RESULTS On March 11, 2020, World Health Organization officially declared COVID-19 a global pandemic. As of May 9, 2022, more than 515 million confirmed cases of COVID-19 were reported globally. While the multisystem effects of COVID-19 are incompletely understood, the role of imaging in diagnosing, monitoring, and prognosticating active disease, long-term effects, and complications is evolving. In the respiratory system, imaging plays an important role in diagnosing, characterizing, and monitoring pulmonary COVID-19 infections, barotrauma, and COVID-19-associated chronic pulmonary opacities and fibrotic-like lung changes. Ultrasonography, computed tomography, and magnetic resonance imaging aid in the timely diagnosis of ischemic, embolic, and thrombotic peripheral and central cardiovascular events, including deep venous thrombosis, pulmonary embolism, myocarditis, and stroke. COVID-19-associated musculoskeletal and peripheral nervous system manifestations include rhabdomyolysis and myonecrosis, plexus and peripheral neuropathies, Guillain-Barré syndrome, and shoulder injury related to vaccine administration. CONCLUSION In athletes, COVID-19 infections and associated effects on cardiovascular, musculoskeletal, neurologic, and respiratory systems require special consideration. With the increasing understanding of the multisystem effects of COVID-19, the role of imaging in diagnosing, monitoring, and prognosticating active disease, long-term effects, and complications is evolving. A comprehensive understanding of imaging indications, COVID-19 imaging features, and organ system effects aids in appropriate imaging utilization and effective patient management and treatments.
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Affiliation(s)
- Ali Rashidi
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA
| | - Jan Fritz
- Department of Radiology, NYU Grossman School of Medicine, New York, New York
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Yanagi M, Hamasaki T, Morita K, Takeda H, Akatsuka J, Endo Y, Hayashi T, Kondo Y. Rhabdomyolysis after Retroperitoneal Laparoscopic Radical Nephrectomy in the Lateral Decubitus Position. J NIPPON MED SCH 2022; 89:466-468. [DOI: 10.1272/jnms.jnms.2022_89-208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Masato Yanagi
- Department of Urology, Nippon Medical School Hospital
| | - Tsutomu Hamasaki
- Department of Urology, Nippon Medical School Musashikosugi Hospital
| | - Kojiro Morita
- Department of Urology, Nippon Medical School Tama Nagayama Hospital
| | - Hayato Takeda
- Department of Urology, Nippon Medical School Hospital
| | - Jun Akatsuka
- Department of Urology, Nippon Medical School Hospital
| | - Yuki Endo
- Department of Urology, Nippon Medical School Hospital
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Agharokh L, Zaniletti I, Yu AG, Lee BC, Hall M, Williams DJ, Wilson KM. Trends in Pediatric Rhabdomyolysis and Associated Renal Failure: A 10-Year Population-Based Study. Hosp Pediatr 2022; 12:718-725. [PMID: 35879468 DOI: 10.1542/hpeds.2021-006484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Rhabdomyolysis in children is a highly variable condition with presentations ranging from myalgias to more severe complications like acute renal failure. We sought to explore demographics and incidence of pediatric rhabdomyolysis hospitalizations and rates of associated renal failure, as our current understanding is limited. METHODS This was a retrospective analysis using the Healthcare Cost and Utilization Project Kids' Inpatient Database to identify children hospitalized with a primary diagnosis of rhabdomyolysis. Data were analyzed for demographic characteristics, as well as geographic and temporal trends. Multivariable logistic regression was used to identify characteristics associated with rhabdomyolysis-associated acute renal failure. RESULTS From 2006 to 2016, there were 8599 hospitalized children with a primary diagnosis of rhabdomyolysis. Overall, hospitalizations for pediatric rhabdomyolysis are increasing over time, with geographic peaks in the South and Northeast regions, and seasonal peaks in March and August. Though renal morbidity was diagnosed in 8.5% of children requiring hospitalization for rhabdomyolysis, very few of these patients required renal replacement therapy (0.41%), and death was rare (0.03%). Characteristics associated with renal failure included male sex, age greater than 15 years, and non-Hispanic Black race. CONCLUSIONS Though renal failure occurs at a significant rate in children hospitalized with rhabdomyolysis, severe complications, including death, are rare. The number of children hospitalized with rhabdomyolysis varies by geographic region and month of the year. Future studies are needed to explore etiologies of rhabdomyolysis and laboratory values that predict higher risk of morbidity and mortality in children with rhabdomyolysis.
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Affiliation(s)
- Ladan Agharokh
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Texas - Southwestern Medical Center, Dallas
| | | | - Andrew G Yu
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Texas - Southwestern Medical Center, Dallas
| | - Benjamin C Lee
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Texas - Southwestern Medical Center, Dallas
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | - Derek J Williams
- Department of Pediatrics, Division of Hospital Medicine, Vanderbilt University, School of Medicine, Nashville, Tennessee
| | - Karen M Wilson
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Rochester, School of Medicine, Rochester, New York
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Alex J, Landa E, Trivedi A, Parsons II LM, Shabo N. Extraordinary Creatine Phosphokinase Levels in Coxsackie B Necrotizing Myopathy Complicated by Rhabdomyolysis. Cureus 2022; 14:e25201. [PMID: 35747057 PMCID: PMC9211034 DOI: 10.7759/cureus.25201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 12/15/2022] Open
Abstract
Coxsackie B infections can have varying clinical presentations. Necrotizing myopathy and rhabdomyolysis with remarkably high creatine phosphokinase levels is a rare complication associated with high morbidity and mortality. A 28-year-old male presented with complaints of weakness, body aches, and decreased urine output. Initial lab work showed a creatine phosphokinase level estimated at 5,366,100 U/l. Initial Coxsackie B4 titers were at 1:160. Muscle biopsy of the right calf revealed necrotizing myopathy consistent with viral myopathy. This case highlights Coxsackie B4 as a potential pathogen that can cause extensive muscle necrosis producing extreme creatine phosphokinase levels leading to rhabdomyolysis. Taking a comprehensive history is essential to identify viral prodromal symptoms to guide broader serological testing for uncommon viral species.
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58
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Toxic Myopathies. Curr Treat Options Neurol 2022. [DOI: 10.1007/s11940-022-00718-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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59
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Nueangphuet P, Hamano T, Hirai T, Sakaguchi Y, Sonoda H, Otsuka M, Yamato O, Hobo S, Ikeda M, Yamaguchi R. Rhabdomyolysis, myoglobinuric nephrosis, and crystalline nephropathy in a captive bottlenose dolphin. J Vet Diagn Invest 2022; 34:668-673. [PMID: 35477373 PMCID: PMC9266508 DOI: 10.1177/10406387221090516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 5-y-old female bottlenose dolphin (Tursiops truncatus) from an aquarium in Japan had clinical signs of anorexia, vomiting, and bradykinesia. Enrofloxacin and lactated Ringer solution were administered for treatment of bacterial infection and for rehydration. Elevations of creatine kinase and aspartate aminotransferase activities were detected on day 4 of treatment, indicating that rhabdomyolysis had developed on day 3. On day 5, serum creatinine and urea concentrations increased and remained high throughout the remaining treatment; the dolphin died on day 16. Postmortem examination revealed massive necrosis of the longissimus dorsi muscles. Histologic examination revealed extensive necrosis of skeletal myofibers, multifocal renal tubular necrosis with intratubular casts and crystals, and suppurative bronchopneumonia. The renal casts labeled positively with anti-myoglobin antibody; expression of aquaporin-1 was decreased in renal tubules compared to normal kidney tissue. To our knowledge, this description of clinicopathologic findings of rhabdomyolysis leading to acute kidney injury with concomitant crystalline nephropathy has not been reported previously in a bottlenose dolphin.
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Affiliation(s)
- Phawut Nueangphuet
- Departments of Veterinary Pathology, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan
| | | | - Takuya Hirai
- Departments of Veterinary Pathology, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan
| | - Yui Sakaguchi
- Veterinary Pharmacology, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan
| | - Hiroko Sonoda
- Veterinary Pharmacology, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan
| | | | - Osamu Yamato
- Departments of Clinical Pathology, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima, Japan
| | - Seiji Hobo
- Domestic Animal Internal Medicine, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima, Japan
| | - Masahiro Ikeda
- Veterinary Pharmacology, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan
| | - Ryoji Yamaguchi
- Departments of Veterinary Pathology, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan
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Wang W, Lu X, Li C, Teng W, Cui W. Rhabdomyolysis induced by rosuvastatin combined with entecavir: a case report. BMC Infect Dis 2022; 22:365. [PMID: 35410138 PMCID: PMC9004004 DOI: 10.1186/s12879-022-07254-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background Rhabdomyolysis is a serious and potentially life threatening condition that can be caused by drugs. We report a case of acute hepatitis B with rhabdomyolysis after treatment with rosuvastatin and entecavir. Case presentation A 72-year-old female was admitted to our hospital due to acute hepatitis B infection. She had taken atorvastatin for 3 months before being admitted to our hospital. After being administered entecavir (ETV) and rosuvastatin to replace atorvastatin, she suffered from muscle pain in both lower limbs and was diagnosed with rhabdomyolysis. After discontinuation of the two drugs, the patient's symptoms subsided and creatine kinase levels returned to normal. We hypothesize that the rhabdomyolysis was caused by the combination of rosuvastatin and ETV. Conclusions We suggest that patients who use rosuvastatin and ETV be made aware of the complication of rhabdomyolysis.
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Affiliation(s)
- Wen Wang
- Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, Liaoning, China
| | - Xu Lu
- Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, Liaoning, China
| | - Chengbo Li
- Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, Liaoning, China
| | - Wei Teng
- Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, Liaoning, China
| | - Wei Cui
- Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, Liaoning, China.
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61
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Uncommon Causes of Rhabdomyolysis. Crit Care Clin 2022; 38:271-285. [DOI: 10.1016/j.ccc.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Masuda Y, Wam R, Paik B, Ngoh C, Choong AM, Ng JJ. Clinical characteristics and outcomes of exertional rhabdomyolysis after indoor spinning: a systematic review. PHYSICIAN SPORTSMED 2022:1-12. [PMID: 35254210 DOI: 10.1080/00913847.2022.2049645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES An increasing number of patients are diagnosed with exertional rhabdomyolysis secondary to indoor spinning. We performed a systematic review to characterize the clinical features of this new clinical entity. METHODS We conducted a thorough literature search on PubMed, Embase, Web of Science, Scopus, and The Cumulative Index to Nursing and Allied Health Literature (CINAHL). Articles published from inception to 23 June 2021 were considered. A two-stage article selection process was performed. Articles that reported clinical characteristics and outcomes in patients with spin-induced exertional rhabdomyolysis (SIER) were included. Quality assessment was performed using the Joanna Briggs Institute checklists. RESULTS There were a total of 22 articles and 97 patients with SIER. Most patients were healthy females who had attended their first spinning session. The mean time to clinical presentation was 3.1 ± 1.5 days. The most common presenting symptoms were myalgia, dark urine, and muscle weakness in the thighs. Seven patients (7.2%) developed acute kidney injury, and two patients (2.1%) required temporary inpatient hemodialysis. Four patients (4.1%) developed thigh compartment syndrome and required fasciotomies. No long-term sequelae or mortality were observed. The mean length of stay was 5.6 ± 2.9 days. CONCLUSIONS Healthcare professionals must have a high index of suspicion for SIER when a patient presents with myalgia, dark urine, or weakness after a recent episode of indoor spinning. Fitness center owners, spinning instructors, and participants should also be better educated about the clinical features and manifestations of SIER.
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Affiliation(s)
- Yoshio Masuda
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Rachel Wam
- Yale-NUS College, National University of Singapore, Singapore
| | - Benjamin Paik
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Clara Ngoh
- Division of Nephrology, Department of Medicine, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Andrew Mtl Choong
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Vascular and Endovascular Surgery, National University Heart Centre, Singapore.,Cardiovascular Research Institute, National University of Singapore, Singapore
| | - Jun Jie Ng
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Vascular and Endovascular Surgery, National University Heart Centre, Singapore
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Relation between Serum Creatine Phosphokinase Levels and Acute Kidney Injury among ST-Segment Elevation Myocardial Infarction Patients. J Clin Med 2022; 11:jcm11041137. [PMID: 35207410 PMCID: PMC8877638 DOI: 10.3390/jcm11041137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/06/2022] [Accepted: 02/15/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Among patients with rhabdomyolysis, the leakage of intracellular skeletal muscle content such as creatine phosphokinase (CPK) into the bloodstream has been associated with an increased risk of acute kidney injury (AKI). We evaluated the possible relationship between serum CPK levels and AKI occurrence among patients with myocyte injury secondary to ST-elevation myocardial infarction (STEMI). Methods: We retrospectively included 2794 patients with STEMI. Patients were stratified according to peak serum CPK levels into mild (<1000 U/L, n = 1603), moderate (1000–5000 U/L, n = 1111), and severe (>5000 U/L, n = 80) categories. The occurrence of AKI was defined by the KDIGO criteria as an increase in serum creatinine (sCR) ≥0.3 mg/dL within 48 h following PCI. The predictive value of CPK for the risk of AKI occurrence was assessed using multivariate logistic regression models. Results: The overall occurrence of AKI was 10.4%. Incidence of AKI showed a gradual increase between patients with mild, moderate, and severe serum CPK level elevations (7.8% vs. 11% vs. 26% respectively; p < 0.001). In multivariate logistic regression models, both moderate or higher (OR 1.6, 95% CI 1.1–2.2; p = 0.01) and severe (OR 2.8 95% CI 1.4–5.6; p = 0.004) serum CPK level elevations were independently associated with AKI. Conclusions: Among STEMI patients, elevated CPK levels were associated with AKI. This association is presumably independent; however, it remains unclear whether it is due to direct toxic (myoglobin-related) or hemodynamic effects (poor left ventricular function). Further studies are required to reveal the underlying mechanism.
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Aldrete J, Peterson CJ, Tarbox JA, Pixley JS. Polymyositis Presenting With Nontraumatic Rhabdomyolysis and Dysphagia: A Case Report. J Investig Med High Impact Case Rep 2022; 10:23247096221074589. [PMID: 35264047 PMCID: PMC8918959 DOI: 10.1177/23247096221074589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Idiopathic inflammatory myopathies (IIMs) are a rare, heterogeneous group of diseases with a characteristic clinical presentation consisting of muscle inflammation and weakness. They often present with accompanying extra-muscular findings, most notably in the skin, lungs, and joints. Inflammatory myopathies are also identified by their characteristic laboratory abnormalities, including a 10- to 50-fold increase in creatinine kinase, elevated liver enzymes, and characteristic electromyography and magnetic resonance imaging findings. Distinct autoimmune markers and clinical phenotypes have advanced our understanding of IIMs and have led to the recognition of 5 distinct entities, each with its unique pathophysiology, autoimmune markers, and clinical features. While autoimmune panels and muscle biopsies help clinicians distinguish one entity from the other, their sensitivity and specificity vary. Of the various inflammatory myopathies, polymyositis remains the most elusive. Often, the diagnosis is ultimately made by combining clinical findings and laboratory data. As our case report illustrates, clinicians must use this constellation of data to initiate treatment for suspected polymyositis despite negative autoimmune panels and negative muscle biopsy.
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Affiliation(s)
| | | | - James A Tarbox
- Texas Tech University Health Sciences Center, Lubbock, USA
| | - John S Pixley
- Texas Tech University Health Sciences Center, Lubbock, USA
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65
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Osmotic Demyelination Syndrome due to Rhabdomyolysis and Hyperosmolar Hyperglycemic Syndrome following Cardiogenic Shock. Case Rep Crit Care 2021; 2021:8083731. [PMID: 34868688 PMCID: PMC8639260 DOI: 10.1155/2021/8083731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/12/2021] [Indexed: 11/17/2022] Open
Abstract
Osmotic demyelination syndrome (ODS) is a relatively rare disease that causes rapid demyelination, resulting in pontine and central nervous system damage with various symptoms, including impaired consciousness. It often occurs when hyponatremia is rapidly corrected. However, it can also occur when a normonatremic patient suddenly develops hypernatremia. A 51-year-old man developed cardiogenic shock with impaired consciousness, hyperCKemia, hypernatremia, and hyperglycemia. Osmotic demyelination syndrome secondary to rhabdomyolysis and hyperosmolar hyperglycemic syndrome was suspected. The patient's fluid volume decreased because of osmotic diuresis caused by hyperglycemia, and the blood sodium level increased rapidly. The latter resulted in ODS, which in turn resulted in a prolonged disturbance of consciousness, from which he has not yet recovered. ODS has been reported as a serious complication of rapid correction of hyponatremia, although it also occurs when normonatremia leads to hypernatremia. This disease is difficult to diagnose, as magnetic resonance imaging (MRI) of the brain is often unremarkable several weeks after its onset. This case of ODS occurred when normonatremia led to hypernatremia, as a result of rhabdomyolysis and hyperosmolar hyperglycemic syndrome. Diagnosis was made based on the MRI brain findings.
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Baeza-Trinidad R. Rhabdomyolysis: A syndrome to be considered. Med Clin (Barc) 2021; 158:277-283. [PMID: 34872769 DOI: 10.1016/j.medcli.2021.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 10/19/2022]
Abstract
Rhabdomyolysis is characterized by the release of intracellular elements after the destruction of skeletal muscle. Is characterized by the presence of muscle pain, weakness, and dark urine, associated with elevated creatine kinase (CK). The causes related to this syndrome are varied, being traumatic etiology, immobilization, sepsis, drugs and alcohol the most frequent. CK values are used for diagnosis and prognosis, being renal dysfunction the most serious complication. Treatment is based on early and intensive fluid therapy to avoid kidney complications.
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Egoryan G, Chaudry S, Yadav K, Dong T, Ozcekirdek E, Ozen E, Rodriguez-Nava G. Dark urine as the initial manifestation of COVID-19: a case report. J Med Case Rep 2021; 15:576. [PMID: 34857045 PMCID: PMC8637504 DOI: 10.1186/s13256-021-03173-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/28/2021] [Indexed: 01/04/2023] Open
Abstract
Background Rhabdomyolysis is defined as a syndrome consisting of muscle necrosis and the release of intracellular muscle components into the bloodstream. Although rhabdomyolysis has been previously reported as an initial presentation or late complication of COVID-19, the data on it is still limited, and currently, there is no single case of COVID-19 in the literature that describes creatine kinase levels of more than 30,000 IU/L. Case presentation A 50-year-old African–American male presented to the hospital with decreased urine output, dark urine color, and constipation for the past couple of days. He was found to have acute kidney injury, liver injury, and creatinine kinase of 359,910 IU/L, for which aggressive intravenous fluid therapy was given. Infectious workup resulted in positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction. Two days after admission, the patient became symptomatic from a coronavirus disease 2019: he developed fever and hypoxia, and was placed on supplemental oxygen and started on a 10-day course of dexamethasone. The patient responded well to the treatment and supportive care for coronavirus disease 2019 and was successfully discharged. Conclusion Clinicians should be cognizant of atypical coronavirus disease 2019 presentations. The spectrum of damage of coronavirus disease 2019 is still an evolving topic, and more research is required to reveal the exact mechanisms by which severe acute respiratory syndrome coronavirus 2 leads to rhabdomyolysis.
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Affiliation(s)
- Goar Egoryan
- Department of Internal Medicine, AMITA Health Saint Francis Hospital, 355 Ridge Ave, Evanston, IL, USA.
| | - Sana Chaudry
- Department of Internal Medicine, AMITA Health Saint Francis Hospital, 355 Ridge Ave, Evanston, IL, USA
| | - Kritika Yadav
- Department of Internal Medicine, AMITA Health Saint Francis Hospital, 355 Ridge Ave, Evanston, IL, USA
| | - Tianyu Dong
- Department of Internal Medicine, AMITA Health Saint Francis Hospital, 355 Ridge Ave, Evanston, IL, USA
| | - Emre Ozcekirdek
- Department of Internal Medicine, AMITA Health Saint Francis Hospital, 355 Ridge Ave, Evanston, IL, USA
| | - Ece Ozen
- Department of Internal Medicine, AMITA Health Saint Joseph Hospital, Chicago, IL, USA
| | - Guillermo Rodriguez-Nava
- Department of Internal Medicine, AMITA Health Saint Francis Hospital, 355 Ridge Ave, Evanston, IL, USA
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Warren M, Dhillon G, Muscat J, Abdulkarim A. Atraumatic Bilateral Acute Compartment Syndrome of the Lower Legs: A Review of the Literature. Cureus 2021; 13:e20256. [PMID: 35018259 PMCID: PMC8739082 DOI: 10.7759/cureus.20256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 12/18/2022] Open
Abstract
Bilateral acute compartment syndrome of the legs is a very rare presentation that requires emergency surgical intervention. Atraumatic bilateral cases are almost unheard of in medicine. There is currently no link between compartment syndrome and cognitive impairment or mental health. A systematic literature search was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines using the following keywords in multiple databases: compartment syndrome, atraumatic, spontaneous, bilateral, both, lower leg, acute, compartmental pressure, and fasciotomy. Atraumatic, bilateral, acute, and confirmed compartment syndrome cases were included. In total, 33 cases of atraumatic bilateral acute compartment syndrome (ABACS) were identified, of those 72.7% of cases were males. A form of cognitive impairment was found in 66% of cases. The medical history of the cases included substance abuse (nine patients), mental health illness (seven patients), and hypothyroidism (four patients). Within the reports, there was evidence of a misdiagnosis or delayed management in 19 cases (57.6%). Creatinine kinase (CK) was measured in 28 cases with a mean CK of 110,893 IU/L. Compartment pressure measurements were used in only 12 cases. A total of 29 cases were managed with bilateral four-compartment fasciotomy. This review highlights that ABACS is a condition with high rates of misdiagnosis or delay in treatment. Associations found included patients with cognitive impairment on presentation, mental health conditions, substance misuse, and elevated levels of CK. In addition, this review demonstrates that this condition is less rare than previously thought with serious morbidity and mortality.
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Affiliation(s)
- Madeline Warren
- Trauma and Orthopaedics, East and North Hertfordshire NHS Trust, Stevenage, GBR
| | - Govind Dhillon
- Trauma and Orthopaedics, East and North Hertfordshire NHS Trust, Stevenage, GBR
| | - Joseph Muscat
- Trauma and Orthopaedics, East and North Hertfordshire NHS Trust, Stevenage, GBR
| | - Ali Abdulkarim
- Trauma and Orthopaedics, University Hospitals Sussex NHS Foundation Trust, Brighton, GBR
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Krusche M, Schneider U, Keller S. Bilateral rhabdomyolysis of the arms after an extensive horse ride. Rheumatology (Oxford) 2021; 60:5878. [PMID: 33725117 DOI: 10.1093/rheumatology/keab244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/05/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Sarah Keller
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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70
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Ali L, Mohammed I, Janjua I, Naeem M, Adeli G, Elalamy O, Alhatou M, Akhtar N, Canibano B, Iqrar A. Acute Myocardial Injury and Rhabdomyolysis in COVID-19 Patients: Incidence and Mortality. Cureus 2021; 13:e18899. [PMID: 34804738 PMCID: PMC8599434 DOI: 10.7759/cureus.18899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 12/28/2022] Open
Abstract
Background Myocardial injury has been defined as an elevated troponin level. The frequency of acute myocardial injury of hospitalized coronavirus disease 2019 (COVID-19) patients ranges from 7% to 36%. COVID-19 patients with cardiovascular disease (CVD) have a four-fold higher risk of mortality (odds ratio, 4.33; CI 95%, 3.16-5.94). In COVID-19 hospitalized patients' study showed mortality rate was 18.5%. Rhabdomyolysis is considered as muscle necrosis and the release of intracellular muscles elements and enzymes into blood. In one of retrospective cohort study of COVID-19 hospitalized patients, incidence of rhabdomyolysis was 16.7%. Materials and methods This retrospective observational study consisted of 413 COVID-19 hospitalized patients. Patients with rhabdomyolysis was defined as creatine kinase level greater than 1,000 U/L and acute myocardial injury was defined as serum high-sensitivity troponin-T for males greater than 30 ng/l and for female greater than 20 ng/l. The primary outcome was in-hospital mortality of COVID-19 patients with acute myocardial injury and rhabdomyolysis. Results The incidence of acute myocardial injury and rhabdomyolysis in hospitalized COVID-19 patients was 23.9% (99) and 15.7% (65), respectively. The mortality rate of in hospitalized COVID-19 patients who developed acute myocardial injury (28.3%) was significantly higher in comparison to patients who developed rhabdomyolysis (13.8%). Discussion The binding of SARS-CoV-2 virus to the angiotensin-converting enzyme 2 (ACE2) is a critical step in the pathophysiology in patients with COVID-19. There may be diverse direct and indirect mechanisms of acute myocardial injury in COVID-19 including ischemic injury, hypoxic injury (MI type 2), direct viral myocarditis, stress cardiomyopathy and systemic cytokine storm. Musculoskeletal injury may be caused by direct viral myositis or indirectly by host immune hyperinflammatory cytokine storm response that leads to skeletal muscle fiber proteolysis and fibrosis. Conclusions Acute myocardial injury and rhabdomyolysis were underreported in COVID-19 patients. The incidence and mortality of acute myocardial injury are higher than that of rhabdomyolysis in COVID-19 hospitalized patients. The outcome was worse in COVID-19 patients with severe acute myocardial injury. Patients with acute myocardial injury and rhabdomyolysis may get benefits from rehabilitation programs.
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Affiliation(s)
- Liaquat Ali
- Neurology, Hamad General Hospital, Doha, QAT.,Neurology, Weill Cornell Medicine, Doha, QAT
| | | | - Imran Janjua
- Internal Medicine, Hamad General Hospital, Doha, QAT
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71
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Paternostro C, Gopp L, Tomschik M, Krenn M, Weng R, Bointner K, Jäger F, Zulehner G, Rath J, Berger T, Zimprich F, Cetin H. Incidence and clinical spectrum of rhabdomyolysis in general neurology: a retrospective cohort study. Neuromuscul Disord 2021; 31:1227-1234. [PMID: 34711480 DOI: 10.1016/j.nmd.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/01/2021] [Accepted: 09/14/2021] [Indexed: 01/04/2023]
Abstract
The objective of this retrospective cohort study was to evaluate demographic, clinical and laboratory characteristics of patients with rhabdomyolysis as defined by a serum creatine kinase (sCK) activity > 950 U/L. A total of 248 patients were recruited from the Department of Neurology, Medical University of Vienna, between 01/2000 and 12/2017, with a median sCK activity of 2,160 U/l (IQR 1,342-4,786). Seizures (31.9%), illicit drugs/alcohol (9.7%) and exercise (8.5%) were the most common trigger factors. Rhabdomyolysis incidence rates in specific neurological diseases as estimated by the ratio between rhabdomyolysis cases and the total number of cases with the corresponding disease were highest in myopathies (49.8/1,000 person-years, 95% CI 32.3-67.4), followed by epilepsy (16.4/1,000 person-years, 95% CI 12.8-20.0) and stroke (11.9/1,000 person-years, 95% CI 8.4-15.4). The half-life of sCK activity was 1.5 days in the total cohort. In myopathies, sCK activity was significantly higher as compared to other disease entities 7 days after the peak measurement (p = 0.0023). Acute kidney injury (AKI) developed in 18 patients (7.3%) with no AKI-related deaths during the study period. In conclusion, rhabdomyolysis occurred in a broad range of neurological entities but was associated with a favorable prognosis in most cases rarely resulting in AKI and death.
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Affiliation(s)
- Chiara Paternostro
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Lorina Gopp
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Matthias Tomschik
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Martin Krenn
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Rosa Weng
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Karl Bointner
- IT-Systems and Communications, Medical University of Vienna, Vienna, Austria
| | - Fiona Jäger
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Gudrun Zulehner
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Jakob Rath
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria.
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Zhao Y, Hao X, Zhu Y, Chen M, Ou M, Zhu T. A Combination of N-Terminal proB-Type Natriuretic Peptide and Myoglobin Can Predict Severe Complications After Major Non-Cardiac Surgery in Elderly Patients: A Prospective Observational Cohort Study. Front Med (Lausanne) 2021; 8:679260. [PMID: 34646835 PMCID: PMC8504450 DOI: 10.3389/fmed.2021.679260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/23/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Previous studies have demonstrated that serum N-terminal proB-type natriuretic peptide (NT-proBNP) was a predictor of adverse cardiovascular outcomes after surgery. We performed a prospective study to evaluate if NT-proBNP could be a sensitive marker of overall postoperative outcomes in older patients undergoing major elective non-cardiac surgery when combined with myoglobin (MYO). Methods: Two hundred and three adults aged ≥65 years were enrolled in the study. The American Society of Anesthesiologists (ASA) physical status of patients were I to IV. Blood samples would be taken before and 2 h after the surgery for each patients and NT-proBNP and MYO concentrations (NT-proBNP baseline/ 2 h and MYO baseline/ 2 h) of these samples would be measured immediately. The primary outcome was moderate to severe complications, which were based on the Clavien–Dindo Classification (CDC) scheme (≥CDC grade 3), and the secondary outcomes were major complications within 30 days after surgery. This study was registered at China Clinical Trial Registry (ChiCTR1900026223, http://www.chictr.org.cn/). Results: Overall, moderate to severe complications occurred in 15 patients (7.4%) and major complications occurred in 18 patients (8.9%). Both preoperative and postoperative NT-proBNP values were independent predictors of moderate to severe complications (area under the curve (AUC), 0.820; 95% CI: 0.728, 0.912, P < 0.001; AUC, 0.785; 95% CI: 0.685, 0.885, P < 0.001). When NT-proBNP baseline and MYO-2 h were combined (NT-proBNP baseline × MYO-2 h), the predictive power was improved (AUC 0.841, 95% CI: 0.758, 0.923, P < 0.001). Conclusions: A combination of perioperative NT-proBNP and postoperative MYO concentrations was a good predictor of postoperative complications in elderly patients who underwent major non-cardiac surgery. Using fast and dynamic tests provided by point-to-care-testing, NT-proBNP and MYO concentration measurements provided useful guidance for therapy before or soon after surgery, thus helping to reduce postoperative complications in elderly patients.
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Affiliation(s)
- Yi Zhao
- Departments of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China.,The Research Units of West China-Chinese Academy of Medical Sciences (2018RU012), West China Hospital of Sichuan University, Chengdu, China
| | - Xuechao Hao
- Departments of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China.,The Research Units of West China-Chinese Academy of Medical Sciences (2018RU012), West China Hospital of Sichuan University, Chengdu, China
| | - Yihao Zhu
- Departments of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China.,The Research Units of West China-Chinese Academy of Medical Sciences (2018RU012), West China Hospital of Sichuan University, Chengdu, China
| | - Mingkai Chen
- Departments of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China.,The Research Units of West China-Chinese Academy of Medical Sciences (2018RU012), West China Hospital of Sichuan University, Chengdu, China
| | - Mengchan Ou
- Departments of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China.,The Research Units of West China-Chinese Academy of Medical Sciences (2018RU012), West China Hospital of Sichuan University, Chengdu, China
| | - Tao Zhu
- Departments of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China.,The Research Units of West China-Chinese Academy of Medical Sciences (2018RU012), West China Hospital of Sichuan University, Chengdu, China
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73
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Zeng W, Tomlinson B. Causes and outcome of rhabdomyolysis in patients admitted to medical wards in the Prince of Wales Hospital. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1329. [PMID: 34532466 PMCID: PMC8422091 DOI: 10.21037/atm-21-3660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/05/2021] [Indexed: 01/04/2023]
Abstract
Background Rhabdomyolysis with a marked elevation of serum creatine kinase (CK) can be caused by various conditions. Acute kidney injury (AKI) is a potential complication of severe rhabdomyolysis and leads to a rapid increase in serum creatinine. Methods This study was performed to identify medical cases diagnosed with rhabdomyolysis and to examine the likely causes. Patients diagnosed with rhabdomyolysis during admission to the medical wards of Prince of Wales Hospital (PWH) in Hong Kong from January 1, 2004 to May 31, 2012 were identified by searching computer records. Details of hospital admissions were retrieved, and the underlying causes of the rhabdomyolysis and clinical outcomes were analyzed. Results There were 95 Chinese patients with a median age of 72 years (range, 22–92 years) assigned a diagnosis of rhabdomyolysis. A mild degree of AKI was defined as an increase of serum creatinine more than 20% above the baseline value before onset of acute illness and with the highest creatinine greater than 120 µmol/L. Mild AKI was identified in 63 patients. Rhabdomyolysis appeared to contribute to a fatal outcome in eight patients who had multiple preexisting morbidities. The maximum CK had a median value of 9,829 U/L (range, 472–258,100 U/L). Twelve patients with peak CK levels <10× the upper limit of normal (ULN) may not have had rhabdomyolysis by this standard definition. Of the remaining 83 patients with maximum CK values >10× the ULN, the most common contributing factors were trauma (n=19) and infection (n=17). Other common underlying causes included drug abuse (heroin and alcohol) and ischemia/immobility. Conclusions Most patients recovered with appropriate medical interventions and had a median hospital stay of 13 days. One patient was thought to have drug-related rhabdomyolysis due to taking bezafibrate during an episode of renal impairment.
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Affiliation(s)
- Weiwei Zeng
- Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Brian Tomlinson
- Faculty of Medicine, Macau University of Science and Technology, Macau, China.,Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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74
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Wang W, Wang Y, Yang J. Protective effects of ischemic postconditioning on skeletal muscle following crush syndrome in the rat. Acta Cir Bras 2021; 36:e360701. [PMID: 34495138 PMCID: PMC8428673 DOI: 10.1590/acb360701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/03/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To investigate the effect of ischemic postconditioning (IPostC) on skeletal
muscle and its optimal protocol. Methods This article is about an animal study of rat model of crush syndrome. Sixty
rats were randomized into nine different IPostC intervention groups and a
control group. The anesthetized rats were subjected to unilateral hindlimb
3-kg compression with a compression device for 6 h, followed by nine
different IPostC intervention protocols. Results Serum levels of creatine kinase (CK) at 3 h post-crush became 2.3-3.9 times
among all 10 groups after crush. At 72 h post-crush, serum CK level was
reduced to 0.28-0.53 time in all intervention groups. The creatinine (CREA)
level in the control group was elevated to 3.11 times at 3 h post-crush and
reduced to1.77 time at 72 h post-crush. The potassium (K+) level in the
control group was elevated to 1.65 and 1.41 time at 3 and 72 h post-crush,
respectively. Conclusions Our IPostC intervention protocols can effectively protect rats from
crush-induced elevation of serum CK, CREA, and K+ levels. The timing of
IPostC intervention should be as early as possible, to ensure the protective
effect.
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Affiliation(s)
- Wei Wang
- First Medical Center of PLA General Hospital, China
| | - Yuan Wang
- First Medical Center of PLA General Hospital, China
| | - Jing Yang
- First Medical Center of PLA General Hospital, China
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Geng Y, Ma Q, Du YS, Peng N, Yang T, Zhang SY, Wu FF, Lin HL, Su L. Rhabdomyolysis is Associated with In-Hospital Mortality in Patients with COVID-19. Shock 2021; 56:360-367. [PMID: 33443364 PMCID: PMC8354485 DOI: 10.1097/shk.0000000000001725] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/02/2020] [Accepted: 01/06/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE Rhabdomyolysis (RM) has been associated with many viral infectious diseases, and associated with poor outcomes. We aim to evaluate the clinical features and outcomes of RM in patients with coronavirus disease 2019 (COVID-19). METHOD This was a single-center, retrospective, cohort study of 1,014 consecutive hospitalized patients with confirmed COVID-19 at the Huoshenshan Hospital in Wuhan, China, between February 17 and April 12, 2020. RESULTS The overall incidence of RM was 2.2%. Compared with patients without RM, those with RM tended to have a higher risk of deterioration. Patients with RM also constituted a greater percentage of patients admitted to the intensive care unit (90.9% vs. 5.3%, P < 0.001) and a greater percentage of patients undergoing mechanical ventilation (86.4% vs. 2.7% P < 0.001). Moreover, patients with RM had laboratory test abnormalities, including the presence of markers of inflammation, activation of coagulation, and kidney injury. Patients with RM also had a higher risk of in-hospital death (P < 0.001). Cox's proportional hazard regression model analysis confirmed that RM indicators, including peak creatine kinase levels > 1,000 IU/L (HR = 6.46, 95% CI: 3.02-13.86) and peak serum myoglobin concentrations > 1,000 ng/mL (HR = 9.85, 95% CI: 5.04-19.28), were independent risk factors for in-hospital death. Additionally, patients with COVID-19 that developed RM tended to have delayed viral clearance. CONCLUSION RM might be an important contributing factor to adverse outcomes in COVID-19 patients. The early detection and effective intervention of RM may help reduce mortality among COVID-19 patients.
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Affiliation(s)
- Yan Geng
- Department of Gastroenterology, 923rd Hospital of PLA Joint Logistics Support Force, Nanning, China
- Department of Infectious Disease, Huoshenshan Hospital, Wuhan, China
| | - Qiang Ma
- Department of Biopharmacy, School of Biotechnology, Southern Medical University, Guangzhou, China
| | - Yong-sheng Du
- Department of Infectious Disease, Huoshenshan Hospital, Wuhan, China
| | - Na Peng
- Department of Intensive Care Unit, General Hospital of Southern Theater Command of PLA, Guangzhou, China
- Department of Intensive Care Unit, Huoshenshan Hospital, Wuhan, China
| | - Ting Yang
- Department of Infectious Disease, Huoshenshan Hospital, Wuhan, China
| | - Shi-yu Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Feng-fu Wu
- 923rd Hospital of PLA Joint Logistics Support Force, Nanning, China
| | - Hua-liang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Lei Su
- Department of Gastroenterology, 920th Hospital of PLA Joint Logistics Support Force, Kunming, China
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Meyer M, Sundaram S, Schafhalter-Zoppoth I. Exertional and CrossFit-Induced Rhabdomyolysis. Clin J Sport Med 2021; 31:e290-e292. [PMID: 34472544 DOI: 10.1097/01.jsm.0000790440.65466.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 02/16/2017] [Indexed: 02/02/2023]
Abstract
ABSTRACT Few publications of exercise-induced rhabomyolysis currently exist in the medical literature besides case reports. However, this condition can be severe, resulting in hospitalization and IV fluid administration to prevent serious sequelae. This report describes a case of exercise-induced rhabdomyolysis caused by a CrossFit workout. A 31-year-old female presented with 2 days of bilateral upper extremity pain and soreness, which began 2 days after she completed a CrossFit workout. Workup revealed an elevated creatine phosphokinase (CPK) of 18 441 U/L, consistent with exercise-induced rhabdomyolysis, and elevated liver function tests and elevated D-dimer, although her renal function was normal. She was hospitalized for 2 days and treated with IV fluids. This case report demonstrates that CrossFit exercises can lead to rhabdomyolysis, highlighting a condition that may be underdiagnosed and underreported.
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Affiliation(s)
- Michelle Meyer
- Department of Internal Medicine, California Pacific Medical Center, San Francisco, California
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77
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Rhabdomyolysis Following Ad26.COV2.S COVID-19 Vaccination. Vaccines (Basel) 2021; 9:vaccines9090956. [PMID: 34579193 PMCID: PMC8472996 DOI: 10.3390/vaccines9090956] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/21/2021] [Accepted: 08/23/2021] [Indexed: 12/23/2022] Open
Abstract
We report the case of a 19-year-old male who complained of myalgia, muscle weakness, and darkened urine two days after receiving his Ad26.COV2.S (Johnson & Johnson, New Brunswick, New Jersey, United States) COVID-19 vaccination. Blood examination revealed an increased creatine kinase (CK) level, and his urinary dipstick tested positive for blood, indicative of acute rhabdomyolysis. Serum creatinine levels were normal. Rhabdomyolysis due to strenuous physical activity was ruled out and further diagnostics excluded an autoimmune cause. Under repeated treatment with intravenous fluid resuscitation (outpatient treatment), his symptoms resolved and peak CK levels of 44,180 U/L returned to almost normal levels within two weeks. Rhabdomyolysis is a rare, potentially fatal vaccine-induced reaction. Further research is needed to better understand the underlying pathomechanism and to investigate whether subcutaneous injection of vaccines may be able to prevent rhabdomyolysis.
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Kruijt N, den Bersselaar LV, Snoeck M, Kramers K, Riazi S, Bongers C, Treves S, Jungbluth H, Voermans N. RYR1-related rhabdomyolysis: a spectrum of hypermetabolic states due to ryanodine receptor dysfunction. Curr Pharm Des 2021; 28:2-14. [PMID: 34348614 DOI: 10.2174/1381612827666210804095300] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/10/2021] [Indexed: 11/22/2022]
Abstract
Variants in the ryanodine receptor-1 gene (RYR1) have been associated with a wide range of neuromuscular conditions, including various congenital myopathies and malignant hyperthermia (MH). More recently, a number of RYR1 variants, mostly MH-associated, have been demonstrated to contribute to rhabdomyolysis events not directly related to anesthesia in otherwise healthy individuals. This review focuses on RYR1-related rhabdomyolysis, in the context of several clinical presentations (i.e., exertional rhabdomyolysis, exertional heat illnesses and MH), and conditions involving a similar hypermetabolic state, in which RYR1 variants may be present (i.e., neuroleptic malignant syndrome and serotonin syndrome). The variety of triggers that can evoke rhabdomyolysis, on their own or in combination, as well as the number of potentially associated complications, illustrates that this is a condition relevant to several medical disciplines. External triggers include but are not limited to strenuous physical exercise, especially if unaccustomed or performed under challenging environmental conditions (e.g., high ambient temperature or humidity), alcohol/illicit drugs, prescription medication (in particular statins, other anti-lipid agents, antipsychotics and antidepressants) infection, or heat. Amongst all patients presenting with rhabdomyolysis, a genetic susceptibility is present in a proportion, with RYR1 being one of the most common genetic causes. Clinical clues for a genetic susceptibility include recurrent rhabdomyolysis, creatine kinase (CK) levels above 50 times the upper limit of normal, hyperCKemia lasting for 8 weeks or longer, drug/medication doses insufficient to explain the rhabdomyolysis event, and a positive family history. For the treatment or prevention of RYR1-related rhabdomyolysis, the RYR1 antagonist dantrolene can be administered, both in the acute phase, or prophylactically in patients with a history of muscle cramps and/or recurrent rhabdomyolysis events. Aside from dantrolene, several other drugs are being investigated for their potential therapeutic use in RYR1-related disorders. These findings offer further therapeutic perspectives for humans, suggesting an important area for future research.
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Affiliation(s)
- Nick Kruijt
- Department of Neurology, Radboud University Medical Centre, Nijmegen. Netherlands
| | | | - Marc Snoeck
- Malignant Hyperthermia Investigation Unit, Canisius Wilhelmina Hospital, Nijmegen. Netherlands
| | - Kees Kramers
- Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen. Netherlands
| | - Sheila Riazi
- Department of Anesthesiology and Pain Medicine, University Health Network, University of Toronto, Toronto, ON. Canada
| | - Coen Bongers
- Department of Physiology, Radboudumc, Nijmegen. Netherlands
| | - Susan Treves
- Department of Biomedicine, University Hospital Basel. Switzerland
| | - Heinz Jungbluth
- Department of Paediatric Neurology - Neuromuscular Service, Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London. United Kingdom
| | - Nicol Voermans
- Department of Neurology, Radboud University Medical Centre, Nijmegen. Netherlands
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79
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Gardner HM, Askenazi DJ, Hoefert JA, Helton A, Wu CL. Acute Kidney Injury Among Children Admitted With Viral Rhabdomyolysis. Hosp Pediatr 2021; 11:878-885. [PMID: 34301717 PMCID: PMC10118290 DOI: 10.1542/hpeds.2020-005108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Infectious etiologies cause a large portion of pediatric rhabdomyolysis. Among pediatric patients with rhabdomyolysis, it is unknown who will develop acute kidney injury (AKI). We sought to test the hypothesis that a viral etiology would be associated with less AKI in children admitted with rhabdomyolysis than a nonviral etiology. METHODS In this single-center retrospective cohort study, patients <21 years of age admitted with acute rhabdomyolysis from May 1, 2010, through December 31, 2018, were studied. The primary outcome was development of AKI, defined by using the Kidney Disease: Improving Global Outcomes guidelines. The primary predictor was identification of viral infection by laboratory testing or clinical diagnosis. Covariates included age, sex, race, insurance provider, presence of proteinuria and myoglobinuria, and initial creatinine kinase and serum urea nitrogen. Routine statistics and multivariable logistic modeling were performed via SAS 9.4 (SAS Institute, Inc, Cary, NC). RESULTS In total, 319 pediatric patients with rhabdomyolysis were studied. The median age was 13 years. Patients were predominately male (69.9%), non-Hispanic Black (55.2%), and publicly insured (45.1%). We found no difference in the rates of AKI in those with a viral diagnosis versus those without a viral diagnosis (30 of 77 [39.0%] vs 111 of 234 [47.4%]; P = .19). Multivariable analysis revealed that viral diagnosis was not associated with the development of AKI. Patients ≥13 years of age, male patients, and those with proteinuria and elevated serum urea nitrogen on admission had increased odds of developing AKI. CONCLUSIONS In our study, viral rhabdomyolysis did not have lower rates of AKI compared with nonviral etiologies of AKI; therefore, providers should consider continued caution in these patients.
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Affiliation(s)
- Hannah M Gardner
- Division of Pediatric Hospital Medicine, Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado
| | | | - Jennifer A Hoefert
- Division of General Academic Pediatrics, Section of Pediatric Hospital Medicine, Saint Louis University and Cardinal Glennon Children's Hospital, St Louis, Missouri
| | - Alexis Helton
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Chang L Wu
- Pediatric Hospital Medicine, Department of Pediatrics
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80
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An easily overlooked cause of acute kidney injury: Answers. Pediatr Nephrol 2021; 36:2015-2017. [PMID: 33415479 DOI: 10.1007/s00467-020-04882-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
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81
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Vallejo AN, Mroczkowski HJ, Michel JJ, Woolford M, Blair HC, Griffin P, McCracken E, Mihalik SJ, Reyes‐Mugica M, Vockley J. Pervasive inflammatory activation in patients with deficiency in very-long-chain acyl-coA dehydrogenase (VLCADD). Clin Transl Immunology 2021; 10:e1304. [PMID: 34194748 PMCID: PMC8236555 DOI: 10.1002/cti2.1304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 05/06/2021] [Accepted: 06/03/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Very-long-chain acyl-CoA dehydrogenase deficiency (VLCADD) is a disorder of fatty acid oxidation. Symptoms are managed by dietary supplementation with medium-chain fatty acids that bypass the metabolic block. However, patients remain vulnerable to hospitalisations because of rhabdomyolysis, suggesting pathologic processes other than energy deficit. Since rhabdomyolysis is a self-destructive process that can signal inflammatory/immune cascades, we tested the hypothesis that inflammation is a physiologic dimension of VLCADD. METHODS All subjects (n = 18) underwent informed consent/assent. Plasma cytokine and cytometry analyses were performed. A prospective case analysis was carried out on a patient with recurrent hospitalisation. Health data were extracted from patient medical records. RESULTS Patients showed systemic upregulation of nine inflammatory mediators during symptomatic and asymptomatic periods. There was also overall abundance of immune cells with high intracellular expression of IFNγ, IL-6, MIP-1β (CCL4) and TNFα, and the transcription factors p65-NFκB and STAT1 linked to inflammatory pathways. A case analysis of a patient exhibited already elevated plasma cytokine levels during diagnosis in early infancy, evolving into sustained high systemic levels during recurrent rhabdomyolysis-related hospitalisations. There were corresponding activated leukocytes, with higher intracellular stores of inflammatory molecules in monocytes compared to T cells. Exposure of monocytes to long-chain free fatty acids recapitulated the cytokine signature of patients. CONCLUSION Pervasive plasma cytokine upregulation and pre-activated immune cells indicate chronic inflammatory state in VLCADD. Thus, there is rationale for practical implementation of clinical assessment of inflammation and/or translational testing, or adoption, of anti-inflammatory intervention(s) for personalised disease management.
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Affiliation(s)
- Abbe N Vallejo
- Division of Pediatric Rheumatology, Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPAUSA
- Department of ImmunologyUniversity of Pittsburgh School of MedicinePittsburghPAUSA
- Children's Hospital of PittsburghUniversity of Pittsburgh Medical CenterPittsburghPAUSA
| | - Henry J Mroczkowski
- Children's Hospital of PittsburghUniversity of Pittsburgh Medical CenterPittsburghPAUSA
- Division of Genetic and Genomic Medicine, Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPAUSA
- Present address:
Department of PediatricsUniversity of Tennessee Health Sciences CenterMemphisTNUSA
| | - Joshua J Michel
- Division of Pediatric Rheumatology, Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Michael Woolford
- Division of Pediatric Rheumatology, Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Harry C Blair
- Department of PathologyUniversity of Pittsburgh School of MedicinePittsburghPAUSA
- Department of Cell BiologyUniversity of Pittsburgh School of MedicinePittsburghPAUSA
- Pittsburgh Veterans Administration Medical CenterPittsburghPAUSA
| | - Patricia Griffin
- Division of Pediatric Rheumatology, Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Elizabeth McCracken
- Children's Hospital of PittsburghUniversity of Pittsburgh Medical CenterPittsburghPAUSA
- Division of Genetic and Genomic Medicine, Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPAUSA
- Center for Rare Disease and TherapyUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Stephanie J Mihalik
- Division of Genetic and Genomic Medicine, Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPAUSA
- Department of PathologyUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Miguel Reyes‐Mugica
- Children's Hospital of PittsburghUniversity of Pittsburgh Medical CenterPittsburghPAUSA
- Department of PathologyUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Jerry Vockley
- Children's Hospital of PittsburghUniversity of Pittsburgh Medical CenterPittsburghPAUSA
- Division of Genetic and Genomic Medicine, Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPAUSA
- Center for Rare Disease and TherapyUniversity of Pittsburgh School of MedicinePittsburghPAUSA
- Department of Human GeneticsUniversity of Pittsburgh Graduate School of Public HealthPittsburghPAUSA
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82
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Naschitz JE. The Swollen Calf of Reperfusion Injury: An Addition to the Spectrum of Pseudothrombophlebitis. Int J Angiol 2021; 30:173-174. [PMID: 34054278 DOI: 10.1055/s-0040-1721805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Jochanan E Naschitz
- Bait Balev Nesher and The Ruth and Bruce Rappaport Faculty of Medicine, Israel Institute of Technology, Technion, Haifa, Israel
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83
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Khu YL, Lewis B, Blackshaw L, Tan SMQ, Bayfield A, Schneider HG, Liew D, Aung AK. Aetiologies and factors associated with poor clinical outcomes in rhabdomyolysis: a retrospective cohort study in an Australian trauma centre. Intern Med J 2021; 51:264-267. [PMID: 33631858 DOI: 10.1111/imj.15183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 11/28/2022]
Abstract
Rhabdomyolysis is a clinical syndrome with significant morbidity and mortality that occurs as a result of traumatic and non-traumatic aetiologies. Acute kidney injury, the need for dialysis, and death, can occur due to rhabdomyolysis. This study explores the aetiologies, clinical outcomes and associated factors for poor outcomes in a cohort of patients with rhabdomyolysis in a tertiary trauma centre in Australia.
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Affiliation(s)
- Yin Li Khu
- Department of General Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Benjamin Lewis
- Department of General Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Lucinda Blackshaw
- Department of General Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Suzanne May Quinn Tan
- Department of General Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.,Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Anna Bayfield
- Department of General Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Hans Gerhard Schneider
- Department of General Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Pathology, The Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Danny Liew
- Department of General Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ar Kar Aung
- Department of General Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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84
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Abstract
Summary: Opioid use and misuse in the United States has been at epidemic proportions and is predicted to increase further in the setting of the Coronavirus disease 19 pandemic. Acute kidney injury is a condition associated with significant morbidity and increased mortality. We review the literature on the effect of opioids on kidney function and critically examine the association between opioid use and acute kidney injury and identify at-risk populations in whom opioids should be used with caution. We also discuss the role of biomarkers in elucidating this condition and propose preventive measures, novel therapeutic options, and research directions.
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Affiliation(s)
- Mary Mallappallil
- Assistant Professor of Medicine, State University of New York at Downstate, Brooklyn, NY; Director of Service Nephrology, Kings County Hospital Center, Health and Hospitals Corporation, Brooklyn, NY.
| | - Siddhartha Bajracharya
- Clinical Instructor of Medicine, State University of New York at Downstate, Brooklyn, NY; Renal Fellow, Kings County Hospital Center, Health and Hospitals Corporation, Brooklyn, NY
| | - Moro Salifu
- Professor and Chairman of Medicine, Chief of Nephrology, State University of New York at Downstate, Brooklyn, NY; Physician Specialist, Kings County Hospital Center, Health and Hospitals Corporation, Brooklyn, NY
| | - Ernie Yap
- Assistant Professor of Medicine, State University of New York at Downstate, Brooklyn, NY; Physician Specialist, Kings County Hospital Center, Health and Hospitals Corporation, Brooklyn, NY
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85
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Yang CW, Li S, Dong Y, Paliwal N, Wang Y. Epidemiology and the Impact of Acute Kidney Injury on Outcomes in Patients with Rhabdomyolysis. J Clin Med 2021; 10:jcm10091950. [PMID: 34062839 PMCID: PMC8125267 DOI: 10.3390/jcm10091950] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Currently, no large, nationwide studies have been conducted to analyze the demographic factors, underlying comorbidities, clinical outcomes, and health care utilization in rhabdomyolysis patients with and without acute kidney injury (AKI). Methods: We queried the National Inpatient Sample of Healthcare Cost and Utilization Project (HCUP) with patients with rhabdomyolysis from 2016 to 2018. The chi-squared test was used to compare categorical variables, and the adjusted Wald test was employed to compare quantitative variables. The logistic regression model was applied to calculate adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) to estimate the impact of AKI on outcomes in patients with rhabdomyolysis. Results: Among 111,085 rhabdomyolysis-related hospitalizations, a higher prevalence of AKI was noticed in older patients (mean age ± SD, 58.2 ± 21.6 vs. 53.8 ± 22.2), Medicare insurance (48.5% vs. 43.2%), and patients with a higher Charlson Comorbidity Index score (CCI 3–5, 15.1% vs. 5.5%). AKI was found to be independently associated with higher mortality (adjusted odds ratio [aOR] 3.33, 95% CI 2.33–4.75), longer hospital stays (adjusted difference 1.17 days, 95% CI: 1.00−1.34), and higher cost of hospital stay (adjusted difference $11,315.05, 95% CI: $9493.02–$13,137.07). Conclusions: AKI in patients hospitalized with rhabdomyolysis is related to adverse clinical outcomes and significant economic and survival burden.
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Affiliation(s)
- Chien-Wen Yang
- Renal Electrolyte and Hypertension Division, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA;
| | - Si Li
- Department of Internal Medicine, Wright Center for Graduate Medical Education, 501 S Washington Ave, Scranton, PA 18505, USA;
- Correspondence:
| | - Yishan Dong
- Department of Internal Medicine, Rochester General Hospital, 1425 Portland Ave, Rochester, NY 14621, USA;
| | - Nitpriya Paliwal
- Department of Internal Medicine, Wright Center for Graduate Medical Education, 501 S Washington Ave, Scranton, PA 18505, USA;
| | - Yichen Wang
- Mercy Internal Medicine Service, Trinity Health of New England, 271 Carew St, Springfield, MA 01104, USA;
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86
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Rhabdomyolysis in Severe COVID-19: Male Sex, High Body Mass Index, and Prone Positioning Confer High Risk. J Surg Res 2021; 266:35-43. [PMID: 33975028 PMCID: PMC8023200 DOI: 10.1016/j.jss.2021.03.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/04/2021] [Accepted: 03/10/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Bedside experience and studies of critically ill patients with coronavirus disease 2019 (COVID-19) indicate COVID-19 to be a devastating multisystem disease. We aim to describe the incidence, associated variables, and outcomes of rhabdomyolysis in critically ill COVID-19 patients. MATERIALS AND METHODS Data for all critically ill adult patients (≥18 years old) admitted to the ICU at a large academic medical center with confirmed COVID-19 between March 13, 2020 and April 18, 2020 were prospectively collected. Patients with serum creatine kinase (CK) concentrations greater than 1000 U/L were diagnosed with rhabdomyolysis. Patients were further stratified as having moderate (serum CK concentration 1000-4999 U/L) or severe (serum CK concentration ≥5000 U/L) rhabdomyolysis. Univariate and multivariate analyses were performed to identify outcomes and variables associated with the development of rhabdomyolysis. RESULTS Of 235 critically ill COVID-19 patients, 114 (48.5%) met diagnostic criteria for rhabdomyolysis. Patients with rhabdomyolysis more often required mechanical ventilation (P < 0.001), prone positioning (P < 0.001), pharmacological paralysis (P < 0.001), renal replacement therapy (P = 0.010), and extracorporeal membrane oxygenation (ECMO) (P = 0.025). They also had longer median ICU length of stay (LOS) (P < 0.001) and hospital LOS (P < 0.001). No difference in mortality was observed. Male sex, patients with morbid obesity, SOFA score, and prone positioning were independently associated with rhabdomyolysis. CONCLUSIONS Nearly half of critically ill COVID-19 patients in our cohort met diagnostic criteria for rhabdomyolysis. Male sex, morbid obesity, SOFA score, and prone position were independently associated with rhabdomyolysis.
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87
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Janjua I, Bashir T, Haq MZU, Arshad MF, Sharif M. Severe Hypothyroidism Presenting With Rhabdomyolysis in a Young Patient. Cureus 2021; 13:e13993. [PMID: 33880311 PMCID: PMC8053249 DOI: 10.7759/cureus.13993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Rhabdomyolysis is an uncommon but potentially life-threatening medical condition. The acute muscle breakdown leads to the release of toxic muscle contents which can damage the kidneys and can cause the development of acute kidney injury (AKI) and fatal electrolyte imbalances associated with high morbidity and mortality. There are a variety of causes including exposure to extremely hot weather, toxins, trauma, certain drugs, and rarely endocrine disorders in particular thyroid dysfunction. It is more common among a certain group of people, for example, enthusiastic athletes, physical laborers, military and police personnel working in hot and humid weather. Moreover, it is also seen in patients using certain medications, and in the elderly following a fall and prolonged laying on the floor. The majority of the patients develop acute kidney failure and treatment with intravenous hydration and the underlying cause remains the mainstay of management. Our case demonstrates the rare occurrence of AKI induced by rhabdomyolysis in patients with severe hypothyroidism. A 36-years-old male presented with generalized body pains, arthralgias, weight gain, and ankle edema of three months duration. On investigations, he was found to have severe hypothyroidism, AKI along with raised creatinine kinase (CK) and myoglobin indicating severe muscle damage. He was treated with intravenous (IV) fluids and oral levothyroxine in accordance with endocrine team advice. This case highlights the significance of investigating acute rhabdomyolysis with thyroid function tests if no other cause is apparent from history like hyperthermia/drugs/toxins as in our case. Timely diagnosis and treatment of underlying pathology improve patient outcomes.
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Affiliation(s)
- Imran Janjua
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
| | - Tabinda Bashir
- Family Medicine, Primary Health Care Corporation, Doha, QAT
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88
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Waldman W, Kabata PM, Dines AM, Wood DM, Yates C, Heyerdahl F, Hovda KE, Giraudon I, Dargan PI, Sein Anand J. Rhabdomyolysis related to acute recreational drug toxicity-A Euro-DEN study. PLoS One 2021; 16:e0246297. [PMID: 33705425 PMCID: PMC7951866 DOI: 10.1371/journal.pone.0246297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background This study was conducted to retrospectively assess the relationships between: rhabdomyolysis (quantified by creatine kinase (CK) activity) and kidney injury (quantified by serum creatinine concentration), sex, age, body temperature on admission, presence of seizures, and agitation or aggression in patients presenting to the Emergency Department with acute recreational drug toxicity. We also investigated the association with the substances ingested. Methods All presentations to the 16 sentinel Euro-DEN centres in 10 European countries with acute recreational drug toxicity during the first year of the Euro-DEN study (October 2013 to September 2014) were considered. Cases that had abnormal CK activity recorded as part of routine clinical care were divided into 3 cohorts depending on peak CK activity. Cases with normal CK activity were included as a control group (4th cohort). Results Only 1,015 (18.4%) of the 5,529 Euro-DEN presentations had CK activity concentration recorded. Of this group 353 (34.8%) had also creatinine concentration measured. There were 375 (36.9%) with minor rhabdomyolysis, 69 (6.8%) with moderate rhabdomyolysis, and 24 (2.4%) with severe rhabdomyolysis; 547 (53.9%) were included in the control group. There was a positive correlation between CK activity and creatinine concentration (correlation coefficient r = 0.71, p<0.0001). There was no correlation between CK activity and body temperature at the time of presentation to the ED (correlation coefficient r = 0.07, p = 0.03). There was a positive correlation between CK activity and length of stay in the hospital (r = 0.31, p<0.001). There was no association between CK activity and the presence of seizures (p = 0.33) or agitation/aggression (p = 0.45), patients age (p = 0.4) or sex (p = 0.25). The 5 most common agents amongst patients presenting with rhabdomyolysis were: cocaine (n = 107; 22.9% presentations), amphetamine (76; 16.2%), cannabis (74; 15.8%), GHB/GBL (72; 15.4%) and heroin (67; 14.3%). The distribution of rhabdomyolysis in 5 most common drugs was (drug; patients with rhabdomyolysis, patients without rhabdomyolysis): cocaine (107, 122), cannabis (74, 117), GHB/GBL (72, 81), amphetamine (76, 66), heroin (67, 70). Conclusions Abnormal values of CK activity occurred in almost half (46.1%) of presentations to the Emergency Department with acute recreational drug toxicity in whom CK activity was measured; however, severe rhabdomyolysis is seen in only a small minority (2.4%). Those with rhabdomyolysis are at significantly higher risk of kidney injury and have a longer length of hospital stay.
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Affiliation(s)
- Wojciech Waldman
- Department of Clinical Toxicology, Medical University of Gdansk, Gdansk, Poland.,Pomeranian Centre of Toxicology, Gdansk, Poland
| | | | - Alison M Dines
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, United Kingdom
| | - David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, United Kingdom.,Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | | | | | | | - Isabelle Giraudon
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | | | - Paul I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, United Kingdom.,Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Jacek Sein Anand
- Department of Clinical Toxicology, Medical University of Gdansk, Gdansk, Poland.,Pomeranian Centre of Toxicology, Gdansk, Poland
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89
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Abstract
Tourette syndrome (TS) is a condition wherein motor and vocal tics occur, provoked by an urge, but often not able to be completely voluntarily controlled. Tics are known to cause physical and emotional risks to quality of life, and in rare extreme cases, may have permanent consequences. We report the first cases, to our knowledge, of rhabdomyolysis due to extreme tic fits in two distinct patients with TS. Both patients presented with severe tics, leading to elevated creatine kinase and a diagnosis of rhabdomyolysis requiring hospitalisation and intravenous fluids. Neither had neuroleptic malignant syndrome. One patient was on concurrent neuroleptic therapy, but his laboratory parameters improved when tics subsided despite continued neuroleptic use. Our cases highlight the potential complication of rhabdomyolysis secondary to severe tic fits independent of neuroleptic use.
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Affiliation(s)
- Ka Loong Kelvin Au
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
| | - Shannon Chiu
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
| | - Irene A Malaty
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
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90
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Jansi Prema KS, Kurien AA. Etiological Spectrum and Histopathological Diagnosis of Rhabdomyolysis Associated Myoglobin Cast Nephropathy in South India. Indian J Nephrol 2021; 31:22-26. [PMID: 33994683 PMCID: PMC8101665 DOI: 10.4103/ijn.ijn_383_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/14/2020] [Accepted: 04/24/2020] [Indexed: 11/21/2022] Open
Abstract
Background and Aims: Rhabdomyolysis occurs due to injury to skeletal muscle fibers and the release of muscle constituents into the circulation. Myoglobin cast nephropathy leading to acute kidney injury is one of the most severe complications of rhabdomyolysis. This is a retrospective study which aims to analyse the clinicopathological features of myoglobin cast nephropathy. Methods: A total of 57 cases of myoglobin cast nephropathy were identified after performing immunohistochemical staining for myoglobin on all renal biopsies with pigment casts. The clinical, laboratory data, histopathological findings and clinical outcome of these cases were evaluated. Results: The mean patient age was 34.47 years (range 17-77) and the male to female ratio was 6.1:1. All patients presented with acute kidney injury with mean serum creatinine of 8.4 mg/dl (range: 1.7 to 20.8 mg/dl). Rhabdomyolysis was clinically suspected only in 31 patients. Along with myoglobin casts, acute tubular injury was present in all the biopsies. The most frequent conditions associated with myoglobin cast nephropathy in our study were snake envenomation and unaccustomed physical activities. A few activities that caused rhabdomyolysis in our patients were unique to India. Conclusion: Clinicians should be aware of the wide spectrum of causes for rhabdomyolysis. The classical clinical and laboratory findings of rhabdomyolysis may not be present in many of the patients. The pathologist must have a high index of suspicion, and immunohistochemical stain should be used to confirm the diagnosis.
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Affiliation(s)
- K S Jansi Prema
- Renopath, Center for Renal and Urological Pathology, Chennai, Tamil Nadu, India
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91
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Gupta S, Thallapally VK, Thirumalareddy J. Rhabdomyolysis Causing Renal Failure Following Cardiopulmonary Resuscitation, Cardioversion, and Myocardial Infarction: A Case Report and Review of the Literature. Cureus 2021; 13:e12666. [PMID: 33604206 PMCID: PMC7880830 DOI: 10.7759/cureus.12666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Rhabdomyolysis is a condition where there is damage of skeletal muscle, causing myoglobin leak into the circulation. We report a case of a 69-year-old female with a history of hypertension, hyperlipidemia, diabetes mellitus, morbid obesity, paroxysmal atrial fibrillation, and chronic kidney disease stage who underwent cardiopulmonary resuscitation following ventricular fibrillation to restore effective cardiac rhythm. After the third attempt of defibrillation she converted to sinus rhythm. Her echocardiography was suggestive of myocardial infarction (MI). On the second day of her hospitalization, she started becoming oliguric and her creatinine started rising up causing acute kidney injury (AKI). The patient’s creatinine kinase (CK) level peaked at 6380 u/L (normal range 26-192 u/L), myoglobin was >20,000 ng/mL (normal range 9-83 ng/mL), and myocardial bound (MB) isoenzyme of CK was 4.5 ng/mL (normal range 0-3.6 ng/mL). Plasma creatinine increased to 5.71 mg/dL and ultimately developed renal failure. She was started on hemodialysis. Her cardiac catheterization was suggestive of MI. Our case highlights that MI, cardiopulmonary resuscitation, and cardioversion can be a cause for myoglobinuric renal failure, which has been rarely reported in the literature before.
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Affiliation(s)
- Sonia Gupta
- Internal Medicine, Creighton University, Omaha, USA
| | | | - Joseph Thirumalareddy
- Internal Medicine, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Omaha, USA
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92
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Arana C, Del Carpio J, Fayos L, Ars E, Ayasreh N, Guirado L, Bover J. Acute Renal Failure Secondary to an Unusual Familial Metabolic Myopathy. Nephron Clin Pract 2021; 145:199-204. [PMID: 33423032 DOI: 10.1159/000512666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/29/2020] [Indexed: 11/19/2022] Open
Abstract
Rhabdomyolysis is a major cause of acute kidney failure. The etiology is diverse, from full-blown crush syndrome to less frequent causes, such as metabolic myopathy. We describe the case of a 35-year-old male with a history of intermittent myalgias who was admitted to hospital with acute renal failure secondary to rhabdomyolysis. Moderate to intense diffuse uptake of technetium-99m was seen in soft tissues at scintigraphy. The diagnosis of metabolic myopathy was confirmed after careful workup and genetic testing.
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Affiliation(s)
- Carolt Arana
- Department of Nephrology, Fundació Puigvert, IIB Sant Pau, RedinRen, Barcelona, Spain,
| | - Jacqueline Del Carpio
- Department of Nephrology, Fundació Puigvert, IIB Sant Pau, RedinRen, Barcelona, Spain.,Department of Nephrology, Arnau de Villanova Hospital, Lleida, Spain
| | - Leonor Fayos
- Department of Nephrology, Fundació Puigvert, IIB Sant Pau, RedinRen, Barcelona, Spain
| | - Elisabet Ars
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona, Spain
| | - Nadia Ayasreh
- Department of Nephrology, Fundació Puigvert, IIB Sant Pau, RedinRen, Barcelona, Spain
| | - Lluís Guirado
- Department of Nephrology, Fundació Puigvert, IIB Sant Pau, RedinRen, Barcelona, Spain
| | - Jordi Bover
- Department of Nephrology, Fundació Puigvert, IIB Sant Pau, RedinRen, Barcelona, Spain
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93
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Chung JJ, Cho ES, Choi JM, Yu JS. Retrospective Comparison of Renal Ultrasonographic and Clinical Findings in Patients with Rhabdomyolysis. J Med Ultrasound 2020; 28:151-155. [PMID: 33282658 PMCID: PMC7709536 DOI: 10.4103/jmu.jmu_95_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/02/2019] [Accepted: 12/10/2019] [Indexed: 11/28/2022] Open
Abstract
Background: This study evaluated the ultrasonographic and clinical findings of two groups with rhabdomyolysis, who showed abnormal or normal ultrasonographic findings of kidneys. Methods: Two groups (n = 78) of abnormal (A) and normal (B) renal ultrasonographic findings were included. Multiple laboratory findings were assessed within 2 days before or after ultrasonography. Student's t-test or Mann–Whitney U-test was used for statistical analysis. Results: The variable causes of rhabdomyolysis were intense exercise, burn, operation, shivering, and drug intoxication, etc. Group A (n = 26; M:F = 19:7) showed enlarged both kidneys, increased parenchymal thickness, and increased (n = 23, 88.5%) or decreased (n = 3, 11.5%) cortical echogenicity. Group A also showed elevated blood urea nitrogen (BUN), creatinine, potassium, and prolonged activated partial thromboplastin time (aPTT), compared with those in Group B (n = 52; M:F = 36:16), and these results were statistically significant (P < 0.01). The myoglobin in serum and urine, creatine kinase, prothrombin time, dark urine, and microscopic hematuria were not statistically different between the two groups. Conclusion: Patients with elevated BUN, creatinine, potassium, and prolonged aPTT showed the ultrasonographic findings of acute kidney injury, but other parameters were not statistically different between the two groups.
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Affiliation(s)
- Jae-Joon Chung
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Suk Cho
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Min Choi
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Sik Yu
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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Kaisang N, Promsawat K, Jantasorn W, Srisont S. Rhabdomyolysis in drug-related deaths. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2020. [DOI: 10.1186/s41935-020-00195-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Abstract
Background
This study aims to detect myoglobin staining in the cases in which were suspected that intoxication was the cause of death.
Materials and method
This study selected the drug-related death cases including those with toxic blood levels of substances. These drug-related death cases were classified into two groups: (1) suggestive of intoxication death group and (2) other causes of death group which was control group. The kidneys of all these cases were immunohistochemically stained with the myoglobin antibody for rhabdomyolysis diagnosis.
Results
There were 50 drug-related deaths separated into 28 study cases and 22 control cases. The positive myoglobin stain was found in 17 cases (60.7%) in the study group and 5 cases (22.7%) in the control group. The difference between two groups was statistically significant (p = 0.007).
Conclusions
Myoglobin detection in kidney by immunohistochemistry should be done to help for confirming the cause of deaths in these drug-related death cases.
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Jheong JH, Hong SK, Kim TH. Acute Kidney Injury After Trauma: Risk Factors and Clinical Outcomes. JOURNAL OF ACUTE CARE SURGERY 2020. [DOI: 10.17479/jacs.2020.10.3.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Weidhase L, de Fallois J, Haußig E, Kaiser T, Mende M, Petros S. Myoglobin clearance with continuous veno-venous hemodialysis using high cutoff dialyzer versus continuous veno-venous hemodiafiltration using high-flux dialyzer: a prospective randomized controlled trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:644. [PMID: 33176824 PMCID: PMC7659077 DOI: 10.1186/s13054-020-03366-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023]
Abstract
Background Myoglobin clearance in acute kidney injury requiring renal replacement therapy is important because myoglobin has direct renal toxic effects. Clinical data comparing different modalities of renal replacement therapy addressing myoglobin clearance are limited. This study aimed to compare two renal replacement modalities regarding myoglobin clearance. Methods In this prospective, randomized, single-blinded, single-center trial, 70 critically ill patients requiring renal replacement therapy were randomized 1:1 into an intervention arm using continuous veno-venous hemodialysis with high cutoff dialyzer and a control arm using continuous veno-venous hemodiafiltration postdilution with high-flux dialyzer. Regional citrate anticoagulation was used in both groups to maintain the extracorporeal circuit. The concentrations of myoglobin, urea, creatinine, β2-microglobulin, interleukin-6 and albumin were measured before and after the dialyzer at 1 h, 6 h, 12 h, 24 h and 48 h after initiating continuous renal replacement therapy. Results Thirty-three patients were allocated to the control arm (CVVHDF with high-flux dialyzer) and 35 patients to the intervention arm (CVVHD with high cutoff dialyzer). Myoglobin clearance, as a primary endpoint, was significantly better in the intervention arm than in the control arm throughout the whole study period. The clearance values for urea and creatinine were higher in the control arm. There was no measurable albumin clearance in both arms. The clearance data for β2-microglobulin and interleukin-6 were non-inferior in the intervention arm compared to those for the control arm. Dialyzer lifespan was 57.0 [38.0, 72.0] hours in the control arm and 70.0 [56.75, 72.0] hours in the intervention arm (p = 0.029). Conclusions Myoglobin clearance using continuous veno-venous hemodialysis with high cutoff dialyzer and regional citrate anticoagulation is better than that with continuous veno-venous hemodiafiltration with regional citrate anticoagulation. Trial registration German Clinical Trials Registry (DRKS00012407); date of registration 23/05/2017. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012407.
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Affiliation(s)
- Lorenz Weidhase
- Medical Intensive Care Unit, University Hospital Leipzig, Leipzig, Saxony, Germany.
| | - Jonathan de Fallois
- Division of Nephrology, Medical Department III, University Hospital Leipzig, Leipzig, Saxony, Germany
| | - Elena Haußig
- Medical Intensive Care Unit, University Hospital Leipzig, Leipzig, Saxony, Germany
| | - Thorsten Kaiser
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Saxony, Germany
| | - Meinhard Mende
- Institute for Medical Informatics, Statistics and Epidemiology, University Leipzig, Leipzig, Saxony, Germany
| | - Sirak Petros
- Medical Intensive Care Unit, University Hospital Leipzig, Leipzig, Saxony, Germany
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Lim AKH, Azraai M, Pham JH, Looi WF, Bennett C. The Association Between Illicit Drug Use and the Duration of Renal Replacement Therapy in Patients With Acute Kidney Injury From Severe Rhabdomyolysis. Front Med (Lausanne) 2020; 7:588114. [PMID: 33240909 PMCID: PMC7680872 DOI: 10.3389/fmed.2020.588114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background and Aims: Acute kidney injury is a known complication of severe rhabdomyolysis. In patients who present to hospital with rhabdomyolysis, illicit drug use is associated with a higher risk of acute kidney injury needing renal replacement therapy (RRT), independent of the peak serum creatine kinase level. The aim of this study was to assess if RRT duration and renal outcomes were also worse in illicit drug use-associated rhabdomyolysis. Methods: We conducted a cohort study of adult patients who presented to Monash Health (Jan 2011–June 2020) with rhabdomyolysis and required RRT. Patients with isolated myocardial injury and cardiac arrest were excluded. We used survival analysis to examine the time to RRT independence, utilizing the Fine-Gray competing risks regression and death as the competing event. A subdistribution hazard ratio (SHR) < 1.0 represents a relatively greater duration of RRT and a worse outcome. Results: We included 101 patients with a mean age of 58 years, of which 17% were cases associated with illicit drug use. The median peak creatine kinase level was 5,473 U/L (interquartile range, 1,795–17,051 U/L). Most patients (79%) initiated RRT within 72 h of admission, at a median serum creatinine of 537 μmol/L (interquartile range, 332–749 μmol/L). In the competing risks analysis, the estimated SHR was 1.48 (95% CI: 0.78–2.84, P = 0.23) for illicit drug use, 0.87 (95% CI: 0.76–0.99, P = 0.041) for the log-transformed peak creatine kinase, and 0.41 (95% CI: 0.25–0.67, P < 0.001) for sepsis. A 50% cumulative incidence of RRT independence occurred at 11 days (95% CI: 8–16 days). Only 5% of patients remained on RRT at 3 months. Conclusion: In rhabdomyolysis-associated acute kidney injury, it is unlikely that patients with illicit drug use-associated rhabdomyolysis require a longer duration of RRT compared to patients with rhabdomyolysis from other causes.
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Affiliation(s)
- Andy K. H. Lim
- Department of General Medicine, Monash Health, Clayton, VIC, Australia
- Department of Nephrology, Monash Health, Clayton, VIC, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
- *Correspondence: Andy K. H. Lim
| | - Meor Azraai
- Department of General Medicine, Monash Health, Clayton, VIC, Australia
| | - Jeanette H. Pham
- Department of General Medicine, Monash Health, Clayton, VIC, Australia
| | - Wenye F. Looi
- Department of General Medicine, Monash Health, Clayton, VIC, Australia
| | - Caitriona Bennett
- Department of General Medicine, Monash Health, Clayton, VIC, Australia
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Revzin MV, Raza S, Srivastava NC, Warshawsky R, D’Agostino C, Malhotra A, Bader AS, Patel RD, Chen K, Kyriakakos C, Pellerito JS. Multisystem Imaging Manifestations of COVID-19, Part 2: From Cardiac Complications to Pediatric Manifestations. Radiographics 2020; 40:1866-1892. [PMID: 33136488 PMCID: PMC7646410 DOI: 10.1148/rg.2020200195] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/27/2020] [Accepted: 09/27/2020] [Indexed: 02/07/2023]
Abstract
Infection with severe acute respiratory syndrome coronavirus 2 results in coronavirus disease 2019 (COVID-19), which was declared an official pandemic by the World Health Organization on March 11, 2020. COVID-19 has been reported in most countries, and as of August 15, 2020, there have been over 21 million cases of COVID-19 reported worldwide, with over 800 000 COVID-19-associated deaths. Although COVID-19 predominantly affects the respiratory system, it has become apparent that many other organ systems can also be involved. Imaging plays an essential role in the diagnosis of all manifestations of the disease and its related complications, and proper utilization and interpretation of imaging examinations is crucial. A comprehensive understanding of the diagnostic imaging hallmarks, imaging features, multisystem involvement, and evolution of imaging findings is essential for effective patient management and treatment. In part 1 of this article, the authors described the viral pathogenesis, diagnostic imaging hallmarks, and manifestations of the pulmonary and peripheral and central vascular systems of COVID-19. In part 2 of this article, the authors focus on the key imaging features of the varied pathologic manifestations of COVID-19, involving the cardiac, neurologic, abdominal, dermatologic and ocular, and musculoskeletal systems, as well as the pediatric and pregnancy-related manifestations of the virus. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Margarita V. Revzin
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.M., A.S.B.); Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (S.R., R.W., C.D., R.D.P., K.C., C.K., J.S.P.); and Department of Diagnostic Radiology, Danbury Radiological Associates, PC, Danbury, Conn (N.C.S.)
| | - Sarah Raza
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.M., A.S.B.); Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (S.R., R.W., C.D., R.D.P., K.C., C.K., J.S.P.); and Department of Diagnostic Radiology, Danbury Radiological Associates, PC, Danbury, Conn (N.C.S.)
| | - Neil C. Srivastava
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.M., A.S.B.); Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (S.R., R.W., C.D., R.D.P., K.C., C.K., J.S.P.); and Department of Diagnostic Radiology, Danbury Radiological Associates, PC, Danbury, Conn (N.C.S.)
| | - Robin Warshawsky
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.M., A.S.B.); Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (S.R., R.W., C.D., R.D.P., K.C., C.K., J.S.P.); and Department of Diagnostic Radiology, Danbury Radiological Associates, PC, Danbury, Conn (N.C.S.)
| | - Catherine D’Agostino
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.M., A.S.B.); Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (S.R., R.W., C.D., R.D.P., K.C., C.K., J.S.P.); and Department of Diagnostic Radiology, Danbury Radiological Associates, PC, Danbury, Conn (N.C.S.)
| | - Ajay Malhotra
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.M., A.S.B.); Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (S.R., R.W., C.D., R.D.P., K.C., C.K., J.S.P.); and Department of Diagnostic Radiology, Danbury Radiological Associates, PC, Danbury, Conn (N.C.S.)
| | - Anna S. Bader
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.M., A.S.B.); Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (S.R., R.W., C.D., R.D.P., K.C., C.K., J.S.P.); and Department of Diagnostic Radiology, Danbury Radiological Associates, PC, Danbury, Conn (N.C.S.)
| | - Ritesh D. Patel
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.M., A.S.B.); Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (S.R., R.W., C.D., R.D.P., K.C., C.K., J.S.P.); and Department of Diagnostic Radiology, Danbury Radiological Associates, PC, Danbury, Conn (N.C.S.)
| | - Kan Chen
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.M., A.S.B.); Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (S.R., R.W., C.D., R.D.P., K.C., C.K., J.S.P.); and Department of Diagnostic Radiology, Danbury Radiological Associates, PC, Danbury, Conn (N.C.S.)
| | - Christopher Kyriakakos
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.M., A.S.B.); Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (S.R., R.W., C.D., R.D.P., K.C., C.K., J.S.P.); and Department of Diagnostic Radiology, Danbury Radiological Associates, PC, Danbury, Conn (N.C.S.)
| | - John S. Pellerito
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.M., A.S.B.); Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (S.R., R.W., C.D., R.D.P., K.C., C.K., J.S.P.); and Department of Diagnostic Radiology, Danbury Radiological Associates, PC, Danbury, Conn (N.C.S.)
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American Football Players in Preseason Training at Risk of Acute Kidney Injury Without Signs of Rhabdomyolysis. Clin J Sport Med 2020; 30:556-561. [PMID: 30119084 DOI: 10.1097/jsm.0000000000000652] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study was designed to identify changes in blood biomarkers that would indicate excessive muscle breakdown during the initial 10 days of preseason training in collegiate American football players and subsequently increase their risk of acute kidney injury (AKI). DESIGN Prospective cohort study. SETTING Preseason, heat acclimatization period. PARTICIPANTS Twenty-five Division I American football players. INTERVENTION Clinical biomarkers for muscle damage were measured during a preseason training camp. Samples were obtained before camp and approximately 5 and 10 days into camp after completion of heat acclimatization training. MAIN OUTCOMES Creatine kinase, myoglobin, lactate dehydrogenase, and creatinine were measured. Glomerular filtration rate (GFR) was calculated. Urine was collected at each blood draw to qualitatively identify hematuria and red blood cells. RESULTS A high percentage of athletes had an asymptomatic reduction in kidney function over the 10-day period. Ten of 23 athletes did have a significant, 31.6%, mean reduction in GFR, placing each at risk of AKI according to Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) classification. The plasma myoglobin for the at risk of AKI group had a mean value 8× above their baseline mean on day 5 and statistically significant mean 13× higher on day 10 than baseline. The not at risk of AKI group did not have significant differences between days 0, 5, and 10. CONCLUSIONS A relatively high percentage of athletes had an asymptomatic reduction in kidney function during the intense preseason training period. 43.4% of athletes in this study had a significant 31.6% mean reduction in GFR over the 10 days. According to RIFLE classification, this placed each athlete "at risk" of AKI.
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100
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HyperCKemia and rhabdomyolysis in the neuroleptic malignant and serotonin syndromes: A literature review. Neuromuscul Disord 2020; 30:949-958. [PMID: 33250373 DOI: 10.1016/j.nmd.2020.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 11/23/2022]
Abstract
Neuroleptic malignant syndrome and serotonin syndrome are two syndromes whose molecular bases remain poorly understood. The phenotypes of both syndromes overlap with other syndromes that have a clear genetic background, in particular RYR1-related malignant hyperthermia. Through a literature review, performed according to the PRISMA guidelines, we aimed to report the clinical features of both syndromes, and the results of genetic testing performed. 10 case series and 99 case reports were included, comprising 134 patients. A male predominance of 58% was found. The median age was 35 (range 4-84) years. Eight patients experienced recurrent episodes of rhabdomyolysis. Genetic analysis was performed in eleven patients (8%), revealing four RYR1 variants, three likely benign (p.Asp849Asn, p.Arg4645Gln, p.Arg4645Gln) and one variant of uncertain significance (p.Ala612Thr). This review underlines that a subset of patients with neuroleptic malignant syndrome and serotonin syndrome develop recurrent episodes of rhabdomyolysis. This recurrent pattern suggests a possible underlying (genetic) susceptibility. However, the genetic background of neuroleptic malignant syndrome and serotonin syndrome has only been investigated to a very limited degree so far. The increasing availability of next generation sequencing offers an opportunity to identify potentially associated genetic backgrounds, especially in patients with recurrent episodes or a positive family history.
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