101
|
Paternoster M, Capasso E, Di Lorenzo P, Mansueto G. Fatal exertional rhabdomyolysis. Literature review and our experience in forensic thanatology. Leg Med (Tokyo) 2018; 35:12-17. [PMID: 30232046 DOI: 10.1016/j.legalmed.2018.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/26/2018] [Accepted: 09/09/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Mariano Paternoster
- Department of Advanced Biomedical Sciences, Legal Medicine Unit, University of Naples Federico II, Via Pansini 5, Edificio 20, 1° piano, 80131 Napoli, Italy.
| | - Emanuele Capasso
- Department of Advanced Biomedical Sciences, Legal Medicine Unit, University of Naples Federico II, Via Pansini 5, Edificio 20, 1° piano, 80131 Napoli, Italy.
| | - Pierpaolo Di Lorenzo
- Department of Advanced Biomedical Sciences, Legal Medicine Unit, University of Naples Federico II, Via Pansini 5, Edificio 20, 1° piano, 80131 Napoli, Italy.
| | - Gelsomina Mansueto
- Department of Advanced Biomedical Sciences, Legal Medicine Unit, University of Naples Federico II, Via Pansini 5, Edificio 20, 1° piano, 80131 Napoli, Italy.
| |
Collapse
|
102
|
Agmatine attenuates rhabdomyolysis-induced acute kidney injury in rats in a dose dependent manner. Life Sci 2018; 208:79-86. [DOI: 10.1016/j.lfs.2018.07.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/09/2018] [Accepted: 07/11/2018] [Indexed: 02/07/2023]
|
103
|
Tesser Poloni JA, Perazella MA. A Rarely Recognized Cause of Acute Kidney Injury in Rhabdomyolysis. Am J Med Sci 2018; 356:e27. [PMID: 30049408 DOI: 10.1016/j.amjms.2017.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 03/20/2017] [Indexed: 11/24/2022]
Affiliation(s)
- José Antonio Tesser Poloni
- Carlos Franco Voegeli Clinical Analysis Laboratory, Santa Casa de Misericórdia de Porto Alegre; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Mark A Perazella
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut.
| |
Collapse
|
104
|
Huang R, Shi M, Guo F, Feng Y, Feng Y, Liu J, Li L, Liang Y, Xiang J, Lei S, Ma L, Fu P. Pharmacological Inhibition of Fatty Acid-Binding Protein 4 (FABP4) Protects Against Rhabdomyolysis-Induced Acute Kidney Injury. Front Pharmacol 2018; 9:917. [PMID: 30135658 PMCID: PMC6092613 DOI: 10.3389/fphar.2018.00917] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/26/2018] [Indexed: 02/05/2023] Open
Abstract
Acute kidney injury (AKI) is a common and potentially life-threatening complication. Studies confirmed that circulating FABP4 depended on renal function of AKI patients. In our previous study, FABP4 was involved in the pathogenesis of I/R-induced AKI. However, the function of FABP4 in rhabdomyolysis-induced AKI remained poorly understood. In the study, we further investigated the effect of FABP4 in a murine model of glycerol injection-induced rhabdomyolysis. Following glycerol injection, the mice developed severe AKI as indicated by acute renal dysfunction and histologic changes, companied by the increased FABP4 expression in the cytoplasm of tubular epithelial cells. Pharmacological inhibition of FABP4 by a highly selective inhibitor BMS309403 significantly reduced serum creatinine level, proinflammatory cytokine mRNA expression of tumor necrosis factor-α, interleukin-6, and monocyte chemoattractant protein 1 as well as attenuated renal tubular damage in glycerol-injured kidneys. Oral administration of FABP4 inhibitor also resulted in a significant attenuation of ER stress indicated by transmission electron microscope analysis and its maker proteins expression of GRP78, CHOP, p-perk, and ATF4 in kidneys of AKI. Furthermore, BMS309403 could attenuate myoglobin-induced ER stress and inflammation in renal proximal tubular epithelial cell line (HK-2). Overall, these data highlighted that renal protection of selective FABP4 inhibitor was substantiated by the reduction of ER stress and inflammation in tubular epithelial cells of rhabdomyolysis-induced injured kidneys and suggested that the inhibition of FABP4 might be a promising therapeutic strategy for AKI treatment.
Collapse
Affiliation(s)
- Rongshuang Huang
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Min Shi
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Fan Guo
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Yuying Feng
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Yanhuan Feng
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Jing Liu
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Lingzhi Li
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Yan Liang
- Core Facility of West China Hospital, Chengdu, China
| | - Jin Xiang
- Laboratory of Clinical Pharmacology, West China Hospital of Sichuan University, Chengdu, China
| | - Song Lei
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, China
| | - Liang Ma
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Ping Fu
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
105
|
Bilbao NA, Kaulfers AMD, Bhowmick SK. Association of Rhabdomyolysis with Uncontrolled Autoimmune Thyroid Disease in Adolescents. AACE Clin Case Rep 2018. [DOI: 10.4158/accr-2017-0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
106
|
Abstract
RATIONALE We report a 45-year-old male patient with unilateral brachial plexopathy following acute carbon monoxide (CO) intoxication. PATIENT CONCERNS The patient suddenly developed severe left upper extremity weakness and cognitive impairment after CO intoxication. DIAGNOSES He showed severe weakness in the left upper extremity and decreased cognitive function during physical examination. Whole body bone scan revealed increased radioisotope uptake in the left shoulder, suggesting rhadomyolysis. Brain magnetic resonance imaging showed high signal intensity in both globus pallidus. The electrodiagnostic finding was compatible with incomplete left total brachial plexopathy (axonopathy). INTERVENTIONS High oxygen therapy and massive intravenous normal saline infusion were administered immediately after acute CO intoxication. Since then, intensive rehabilitation treatment has been provided. OUTCOME Despite having received medical and rehabilitation treatment, the patient has not recovered severe weakness in the left upper extremity and decline in cognition. LESSONS Localized swelling in the left shoulder caused by rhabdomyolysis may be a key mechanism in developing unilateral brachial plexopathy after acute CO intoxication. The early diagnosis and treatment of rhadomyolysis might be important preventing peripheral neuropathy. An electrodiagnostic study may be helpful for diagnosis of peripheral neuropathy after CO intoxication and prediction of patient's prognosis.
Collapse
|
107
|
TREATMENT OF SUSPECTED EXERTIONAL MYOPATHY USING DANTROLENE IN A COYOTE ( CANIS LATRANS). J Zoo Wildl Med 2018; 49:508-510. [PMID: 29900791 DOI: 10.1638/2017-0225.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A 3-yr-old spayed female coyote ( Canis latrans) developed clinical signs of exertional myopathy after fighting with a conspecific. A diagnosis of exertional myopathy was made based on physical examination findings, probable myoglobinuria, and elevations in serum creatinine kinase activity, alanine aminotransferase activity, and potassium concentration. Dantrolene, a hydantoin analog, as well as supportive and symptomatic therapies, was used to successfully treat exertional myopathy. This is the first reported use of dantrolene in wildlife or zoo animals.
Collapse
|
108
|
Davies N, English W, Grundlingh J. MDMA toxicity: management of acute and life-threatening presentations. ACTA ACUST UNITED AC 2018; 27:616-622. [DOI: 10.12968/bjon.2018.27.11.616] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nicola Davies
- Senior Sister, Emergency Department, Royal London Hospital
| | - William English
- NIHR Academic Clinical Fellow in General Surgery, Royal London Hospital
| | - Johann Grundlingh
- Emergency Medicine and Intensive Care Consultant, Royal London Hospital
| |
Collapse
|
109
|
Ho CWG, Yang SH, Wong CH, Chong SJ. High-voltage electrical injury complicated by compartment syndrome and acute kidney injury with successful limb salvage: A case report and review of the literature. Int J Surg Case Rep 2018; 48:38-42. [PMID: 29787959 PMCID: PMC6026718 DOI: 10.1016/j.ijscr.2018.04.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 04/30/2018] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Although an uncommon form of admission to a burns centre, the deep, penetrating nature of noxious currents mean that electrical burns have the most catastrophic consequences of all burn injuries. Understanding the physics of electricity is crucial to explaining the mechanisms of tissue damage and organ failure in electrical injuries which necessitate special management above and beyond that of regular thermal burns. PRESENTATION OF CASE We present a young man who suffered significant occupation-related electrical burns that was complicated by compartment syndrome, rhabdomyolysis and acute kidney injury. He required multiple surgeries (including fasciotomy as well as soft tissue reconstruction), critical care and lengthy rehabilitation. DISCUSSION Rhabdomyolysis is common sequela of electrical burns and may result in severe and permanent metabolic and renal impairment. High cut-off dialysis membranes have shown great promise in myoglobin removal but further studies are required to determine whether this improves clinical outcomes. Debridement and decompression are the cornerstones of initial surgical intervention and are crucial to minimising infectious complications and preserving vital structures. Free tissue transfer has become increasingly popular, but the ideal timing of microsurgery is still uncertain. Nonetheless, pedicled flaps remain widely used and still have an important role in reconstruction of electrical burns. CONCLUSION Patients with electrical injuries have several unique acute manifestations that differ from other burns. Prognosticating outcomes is difficult, as the full scale of damage is seldom immediately evident. Multiple organ systems are often affected, which makes the treatment of such patients exceptionally challenging, multi-disciplinary and resource-intensive.
Collapse
Affiliation(s)
- Christopher Wei Guang Ho
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road Singapore, 169608, Singapore.
| | - Shi-Hui Yang
- Department of General Surgery, Singapore General Hospital, Outram Road Singapore, 169608, Singapore.
| | - Chu Hui Wong
- Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road Singapore, 229899, Singapore.
| | - Si Jack Chong
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road Singapore, 169608, Singapore.
| |
Collapse
|
110
|
Díaz-Tejeiro R, Regidor D, Morales J, Padrón M, Cueto L, Muñoz MA, Torres M, Ahijado FJ, García Díaz JE. Acute renal failure due to rhabdomyolysis. Renal replacement therapy with intermediate cut-off membranes (EMIC2). Nefrologia 2018; 38:664-665. [PMID: 29778556 DOI: 10.1016/j.nefro.2017.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/08/2017] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - Dabaiba Regidor
- Servicio Nefrología, Hospital Virgen de la Salud, Toledo, España
| | - Jorge Morales
- Servicio Nefrología, Hospital Virgen de la Salud, Toledo, España
| | - Mayte Padrón
- Servicio Nefrología, Hospital Virgen de la Salud, Toledo, España
| | - Laura Cueto
- Servicio Nefrología, Hospital Virgen de la Salud, Toledo, España
| | | | - Marta Torres
- Servicio Nefrología, Hospital Virgen de la Salud, Toledo, España
| | | | | |
Collapse
|
111
|
Kok SXS, Tan TJ. Clinics in diagnostic imaging (179). Severe rhabdomyolysis complicated by myonecrosis. Singapore Med J 2018; 58:467-472. [PMID: 28848989 DOI: 10.11622/smedj.2017081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A 32-year-old man presented to the emergency department with severe right lower limb pain and swelling of three days' duration. He had multiple prior admissions for recurrent seizures and suicide attempts. Markedly elevated serum creatine kinase levels and urine myoglobinuria were consistent with a diagnosis of rhabdomyolysis. Initial magnetic resonance imaging of the right lower limb revealed diffuse muscle oedema and features of myositis in the gluteal muscles and the adductor, anterior and posterior compartments of the thigh. Follow-up magnetic resonance imaging performed 11 days later showed interval development of areas of myonecrosis and haemorrhage. The causes, clinical presentation and imaging features of rhabdomyolysis are discussed.
Collapse
Affiliation(s)
| | - Tien Jin Tan
- Department of Diagnostic Radiology, Changi General Hospital, Singapore
| |
Collapse
|
112
|
Magaz MDLM, Esteban JA, Díaz MH, Peroni JH, Rodríguez CO, Martínez B. [Clinical variables associated with rhabdomyolysis and its complications in elderly patients. A retrospective cohort study]. Rev Esp Geriatr Gerontol 2018; 53:171-172. [PMID: 28890142 DOI: 10.1016/j.regg.2017.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/29/2017] [Accepted: 08/02/2017] [Indexed: 06/07/2023]
Affiliation(s)
- María de Las Mercedes Magaz
- Central de Emergencias, Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Jorge Ariel Esteban
- Central de Emergencias, Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mario Hernán Díaz
- Central de Emergencias, Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jose Hector Peroni
- Central de Emergencias, Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Christian Omar Rodríguez
- Central de Emergencias, Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Bernardo Martínez
- Central de Emergencias, Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
113
|
Lee CW, Choi SW, Lee DS, Gil E, Park CM. Clinical Significance of Creatine Kinase Elevation in Critically Ill Patients. JOURNAL OF ACUTE CARE SURGERY 2018. [DOI: 10.17479/jacs.2018.8.1.13] [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
Affiliation(s)
- Chi-Woo Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Wook Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dae-Sang Lee
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eunmi Gil
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chi-Min Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
114
|
Pastore Neto M, Gonçalves RV, Machado CJ, Resende V. Factors associated with changes in creatine phosphokinase (CPK) in trauma patients submitted to the "Red Wave", with evolution to rhabdomyolysis. Rev Col Bras Cir 2018; 45:e1604. [PMID: 29668808 DOI: 10.1590/0100-6991e-20181604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/22/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify and analyze factors associated with plasma creatine phosphokinase (CPK) levels in trauma victims with progression to rhabdomyolysis. METHODS we conducted a prospective, longitudinal study, with 50 patients submitted to the "Red Wave" protocol, with evolution to rhabdomyolysis after hospital admission. We studied the variables age, gender, trauma scores, mechanism and outcome, CPK at admission and final, intervals of days between laboratory evaluations, surgery and complications. We stratified CPK values in <500U/L, ≥500 - <1000 U/L, and ≥1000U/L, with calculation of the difference between the initial and final values. RESULTS at admission, 83% of patients (n=39) had CPK≥1000U/L, with predominance of blunt trauma and thoracic injury (p<0.05), as well as orthopedic fracture, acute renal failure and gastrointestinal bleeding, CPK being lower in those without acute renal injury, with a trend towards statistical significance. There were no differences in final CPK stratification. Factors that were independently associated with the greater CPK variation were, positively, hospitalization time greater than one week and compartment syndrome, and negatively, acute renal injury. CONCLUSION the CPK level of 1000U/L remains the lower limit, with importance for early intervention in worsening conditions such as digestive hemorrhage, acute renal injury and compartment syndrome, which implied greater absolute differences between initial and final CPK, in addition to blunt trauma, thoracic injury and orthopedic fracture.
Collapse
Affiliation(s)
- Mario Pastore Neto
- Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Carla Jorge Machado
- Department of Preventive and Social Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Vivian Resende
- Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| |
Collapse
|
115
|
Mulay SR, Shi C, Ma X, Anders HJ. Novel Insights into Crystal-Induced Kidney Injury. KIDNEY DISEASES 2018; 4:49-57. [PMID: 29998119 DOI: 10.1159/000487671] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/14/2018] [Indexed: 01/04/2023]
Abstract
Background The entity of crystal nephropathies encompasses a spectrum of different kidney injuries induced by crystal-formed intrinsic minerals, metabolites, and proteins or extrinsic dietary components and drug metabolites. Depending on the localization and dynamics of crystal deposition, the clinical presentation can be acute kidney injury, progressive chronic kidney disease, or renal colic. Summary The molecular mechanisms involving crystal-induced injury are diverse and remain poorly understood. Type 1 crystal nephropathies arise from crystals in the vascular lumen (cholesterol embolism) or the vascular wall (atherosclerosis) and involve kidney infarcts or chronic ischemia, respectively. Type 2 crystal nephropathies arise from intratubular crystal deposition causing obstruction, interstitial inflammation, and tubular cell injury. NLRP3 inflammasome and necroptosis drive renal necroinflammation in acute settings. Type 3 is represented by crystal and stone formation in the draining urinary tract, i.e., urolithiasis, causing renal colic and chronic obstruction. Key Messages Dissecting the types of injury is the first step towards a better understanding of the pathophysiology of crystal nephropathies. Crystal-induced acti-vation of the inflammasome and necroptosis, crystal adhesion, crystallization inhibitors, extratubulation, and granulo-ma formation are only a few of certainly many involved pathomechanisms that deserve further studies to eventually form the basis for innovative cures for these diseases.
Collapse
Affiliation(s)
- Shrikant R Mulay
- Division of Nephrology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU Munich, Munich, Germany
| | - Chongxu Shi
- Division of Nephrology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU Munich, Munich, Germany
| | - Xiaoyuan Ma
- Division of Nephrology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU Munich, Munich, Germany
| | - Hans Joachim Anders
- Division of Nephrology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU Munich, Munich, Germany
| |
Collapse
|
116
|
Rouillon J, Lefebvre T, Denard J, Puy V, Daher R, Ausseil J, Zocevic A, Fogel P, Peoc'h K, Wong B, Servais L, Voit T, Puy H, Karim Z, Svinartchouk F. High urinary ferritin reflects myoglobin iron evacuation in DMD patients. Neuromuscul Disord 2018; 28:564-571. [PMID: 29776718 DOI: 10.1016/j.nmd.2018.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 12/26/2017] [Accepted: 03/14/2018] [Indexed: 12/15/2022]
Abstract
Duchenne muscular dystrophy (DMD) is an X-linked disease caused by mutations in the dystrophin gene leading to the absence of the normal dystrophin protein. The efforts of many laboratories brought new treatments of DMD to the reality, but ongoing and forthcoming clinical trials suffer from absence of valuable biomarkers permitting to follow the outcome of the treatment day by day and to adjust the treatment if needed. In the present study the levels of 128 urinary proteins including growth factors, cytokines and chemokines were compared in urine of DMD patients and age related control subjects by antibody array approach. Surprisingly, statistically significant difference was observed only for urinary ferritin whose level was 50 times higher in young DMD patients. To explain the observed high urinary ferritin content we analysed the levels of iron, iron containing proteins and proteins involved in regulation of iron metabolism in serum and urine of DMD patients and their age-matched healthy controls. Obtained data strongly suggest that elevated level of urinary ferritin is functionally linked to the renal management of myoglobin iron derived from leaky muscles of DMD patients. This first observation of the high level of ferritin in urine of DMD patients permits to consider this protein as a new urinary biomarker in muscular dystrophies and sheds light on the mechanisms of iron metabolism and kidney functioning in DMD.
Collapse
Affiliation(s)
| | - Thibaud Lefebvre
- INSERM U1149 CNRS ERL 8252, Centre de Recherche sur l'inflammation, Université Paris Diderot, site Bichat, Sorbonne Paris Cité, France, 16 rue Henri Huchard, 75018 Paris, France; Laboratory of excellence, GR-Ex, Paris, France
| | | | - Vincent Puy
- Unité INSERM U1088, CURS-Université de Picardie Jules Verne, Amiens, France; Laboratoire de Biochimie, CHU Amiens, F-80054 Amiens, France
| | - Raed Daher
- INSERM U1149 CNRS ERL 8252, Centre de Recherche sur l'inflammation, Université Paris Diderot, site Bichat, Sorbonne Paris Cité, France, 16 rue Henri Huchard, 75018 Paris, France; Laboratory of excellence, GR-Ex, Paris, France
| | - Jérôme Ausseil
- Unité INSERM U1088, CURS-Université de Picardie Jules Verne, Amiens, France; Laboratoire de Biochimie, CHU Amiens, F-80054 Amiens, France
| | | | | | - Katell Peoc'h
- INSERM U1149 CNRS ERL 8252, Centre de Recherche sur l'inflammation, Université Paris Diderot, site Bichat, Sorbonne Paris Cité, France, 16 rue Henri Huchard, 75018 Paris, France
| | - Brenda Wong
- Division of Pediatric Neurology, Cincinnati Children's Hospital Medical Center, USA
| | - Laurent Servais
- Service of Clinical Trials and Databases, Institut de Myologie, Paris, France
| | - Thomas Voit
- University College London, NIHR Biomedical Research Centre, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Herve Puy
- INSERM U1149 CNRS ERL 8252, Centre de Recherche sur l'inflammation, Université Paris Diderot, site Bichat, Sorbonne Paris Cité, France, 16 rue Henri Huchard, 75018 Paris, France; Laboratory of excellence, GR-Ex, Paris, France
| | - Zoubida Karim
- INSERM U1149 CNRS ERL 8252, Centre de Recherche sur l'inflammation, Université Paris Diderot, site Bichat, Sorbonne Paris Cité, France, 16 rue Henri Huchard, 75018 Paris, France; Laboratory of excellence, GR-Ex, Paris, France
| | | |
Collapse
|
117
|
Bender J, Chew R, Lin BB, Athan E. Severe Rhabdomyolysis Associated With RSV. Open Forum Infect Dis 2017; 5:ofx273. [PMID: 29354662 PMCID: PMC5767957 DOI: 10.1093/ofid/ofx273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/20/2017] [Indexed: 01/04/2023] Open
Abstract
Severe rhabdomyolysis is associated with morbidity and mortality. We report on a previously well male who developed severe rhabdomyolysis, sepsis, and multi-organ failure. The patient made a complete recovery. Extensive microbiological testing was only positive for RSV, making this the first reported case of adult RSV-related rhabdomyolysis in the literature.
Collapse
Affiliation(s)
- James Bender
- Junior Medical Workforce, Barwon Health, Geelong, Australia
| | - Rusheng Chew
- Department of Infectious Diseases, Barwon Health, Geelong, Australia
| | - Belinda Bin Lin
- Department of Infectious Diseases, Barwon Health, Geelong, Australia
| | - Eugene Athan
- Department of Infectious Diseases, Barwon Health, Deakin University, Geelong, Australia
| |
Collapse
|
118
|
Acar D, Gülpembe M, Yıldız CG, Özdamar EN, Açıkgöz K, Çağlar A, Cander B. The reno-protective effects of atorvastatin in crush syndrome and rhabdomyolysis:is there a dilemma? Turk J Med Sci 2017; 47:1920-1924. [PMID: 29306258 DOI: 10.3906/sag-1610-48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim: We aim to determine the effects of low-dose atorvastatin treatment together with crush fluid resuscitation on renal functions and muscle enzyme levels in a rat model of crush syndrome. Materials and methods: The study involved female Wistar Albino rats weighing 250-300 g that were housed with free access to food and water. The crush model was obtained by compression. Rats were randomly divided into four groups: control (C) group, atorvastatin + crush fluid (ACF) group, crush fluid (CF) group, and hypertonic saline (%3) + mannitol + sodium bicarbonate (SM) group. Blood was obtained at 24, 48, and 72 h, and serum creatinine kinase, myoglobin, urea, creatinine, and lactate dehydrogenase levels were studied.Results: All parameters were statistically significantly higher in the control group than in the treatment groups at all hours. However, there was no statistically significant difference among treatment groups regarding any of the parameters.Conclusion: This is the first study determining the role of atorvastatin in the treatment of renal ischemia/reperfusion injury in a crush syndrome and rhabdomyolysis model setting. Larger studies with different atorvastatin doses are required to define the role of this drug in the treatment of renal ischemia/reperfusion injury during crush syndrome.
Collapse
|
119
|
Gupta P, Verma PK. Acute kidney injury following rhabdomyolysis and sepsis after non-poisonous desert monitor bite. Indian J Anaesth 2017; 61:837-839. [PMID: 29242657 PMCID: PMC5664890 DOI: 10.4103/ija.ija_241_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The desert monitor, Varanus griseus, is a species of desert monitor lizard found in North-Western India. They are believed to be non-poisonous. We report a case of Indian desert monitor bite leading to acute renal failure following rhabdomyolysis and severe sepsis. Prompt diagnosis and treatment resulted in the favourable outcome. This is author's intent to highlight the complication that may occur after Indian desert monitor bite.
Collapse
Affiliation(s)
- Poonam Gupta
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Pradeep Kumar Verma
- Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| |
Collapse
|
120
|
Mehta V, Chowdhary V, Lin C, Jbara M, Hanna S. Compartment syndrome of the hand: A case report and review of literature. Radiol Case Rep 2017; 13:212-215. [PMID: 29487658 PMCID: PMC5826729 DOI: 10.1016/j.radcr.2017.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 11/02/2017] [Accepted: 11/06/2017] [Indexed: 11/05/2022] Open
Abstract
Elevation of pressure within tightly bound myofascial compartments has detrimental consequences if not treated promptly, leading to a loss of circulation, ischemia, myonecrosis, nerve damage, and limb loss. They are commonly seen in the distal upper and lower extremities; however, compartment syndrome of the hand is rarely encountered and prompt recognition can prevent permanent damage and tissue loss. This case study presents a complicated case of compartment syndrome of the hand and discusses the interrelationship between compartment syndrome and rhabdomyolysis. An emphasis is placed on pathophysiology of this relationship to allow a better understanding of the imaging features as well as early clinical recognition of compartment syndrome. Magnetic resonance imaging findings are specifically discussed as it remains the best imaging tool to evaluate the extent of the damage and surgical planning.
Collapse
Affiliation(s)
- Varun Mehta
- Staten Island University Hospital, Department of Radiology, 475 Seaview Ave, Staten Island, NY 10305, USA
| | - Varun Chowdhary
- Staten Island University Hospital, Department of Radiology, 475 Seaview Ave, Staten Island, NY 10305, USA
| | - Cheryl Lin
- Staten Island University Hospital, Department of Radiology, 475 Seaview Ave, Staten Island, NY 10305, USA
| | - Marlena Jbara
- Staten Island University Hospital, Department of Radiology, 475 Seaview Ave, Staten Island, NY 10305, USA
| | - Shirley Hanna
- Staten Island University Hospital, Department of Radiology, 475 Seaview Ave, Staten Island, NY 10305, USA
| |
Collapse
|
121
|
Sakthirajan R, Dhanapriya J, Varghese A, Saravanakumar K, Dineshkumar T, Balasubramaniyan T, Gopalakrishnan N, Abraham Kurien A. Clinical profile and outcome of pigment-induced nephropathy. Clin Kidney J 2017; 11:348-352. [PMID: 29942498 PMCID: PMC6007272 DOI: 10.1093/ckj/sfx121] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 09/07/2017] [Indexed: 12/21/2022] Open
Abstract
Background Pigment nephropathy represents one of the most severe complications of rhabdomyolysis or hemolysis. Methods We performed a retrospective observational study to analyze the etiology, clinical manifestation, laboratory profile and outcome in patients with biopsy-proven pigment-induced nephropathy between January 2011 and December 2016. History, clinical examination findings, laboratory investigations and outcome were recorded. Results A total of 46 patients were included with mean follow-up of 14 ± 5.5 months. Mean age was 40.15 ± 12.3 years, 65% were males (male:female, 1.8:1) and ∼37 (80.4%) had oliguria. Mean serum creatinine at presentation and peak creatinine were 7.5 ± 2.2 and 12.1 ± 4.3 mg/dL, respectively. Evidence of rhabdomyolysis was noted in 26 patients (64%) and hemolysis in 20 patients (36%). Etiology of rhabdomyolysis include snake envenomation (10 patients), seizures (7), strenuous exercise (5), wasp sting (2) and rifampicin induced (2). The causes of hemolysis include rifampicin induced (7 patients), sepsis (5), malaria (3), mismatched blood transfusion/transfusion reaction (3) and paroxysmal nocturnal hemoglobinuria (2). On renal biopsy, two patients had acute interstitial nephritis and two had immunoglobulin A deposits in addition to pigment nephropathy. All except one (97.8%) required hemodialysis (HD) during hospital stay and mean number of HD sessions was 9 ± 2. A total of three patients with sepsis/disseminated intravascular coagulation died, all had associated hemolysis. On statistical analysis, there was no difference between AKI due to rhabdomyolysis and hemolysis except for high creatine phosphokinase in patients with rhabdomyolysis and Lactate dehydrogenase level in patients with hemolysis. At mean follow-up, five patients (12%) progressed to chronic kidney disease (CKD). Conclusions Pigment nephropathy due to rhabdomyolysis and hemolysis is an important cause of renal failure requiring HD. The prognosis was relatively good and depends on the etiology; however, long-term studies and follow-up are needed to assess the true incidence of CKD due to pigment nephropathy.
Collapse
Affiliation(s)
- Ramanathan Sakthirajan
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India
| | - Jeyachandran Dhanapriya
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India
| | - Arun Varghese
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India
| | - Karunamoorthy Saravanakumar
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India
| | - Thanigachalam Dineshkumar
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India
| | - Thopalan Balasubramaniyan
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India
| | - Natarajan Gopalakrishnan
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India
| | - Anila Abraham Kurien
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India
| |
Collapse
|
122
|
Admission hyperphosphatemia increases the risk of acute kidney injury in hospitalized patients. J Nephrol 2017; 31:241-247. [PMID: 28975589 DOI: 10.1007/s40620-017-0442-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 09/01/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Evidence on the association between elevated admission serum phosphate and risk of in-hospital acute kidney injury (AKI) is limited. The aim of this study was to assess the risk of AKI in hospitalized patients stratified by admission serum phosphate level. METHODS This is a single-center retrospective study conducted at a tertiary referral hospital. All hospitalized adult patients who had admission phosphate measurement available between January and December 2013 were enrolled. Admission phosphate was categorized into 6 groups (< 2.4, 2.4-2.9, 2.9-3.4, 3.4-3.9, 3.9-4.4, and ≥ 4.4 mg/dl). The primary outcome was in-hospital AKI occurring after hospital admission. Logistic regression analysis was performed to obtain the odds ratio of AKI for various admission phosphate strata using the phosphate 2.4-2.9 mg/dl level (lowest incidence of AKI) as the reference group. RESULTS After excluding patients with end-stage renal disease (ESRD), without serum phosphate measurement, and those with AKI at time of admission, a total of 5036 patients were studied. Phosphate levels of < 2.4 and ≥ 4.4 mg/dl were found in 458 (9.1%) and 585 (11.6%) patients, respectively. In-hospital AKI occurred in 595 (11.8%) patients. The incidence of AKI among patients with admission phosphate < 2.4, 2.4-2.9, 2.9-3.4, 3.4-3.9, 3.9-4.4, and ≥ 4.4 mg/dl was 10.5, 9.5, 11.8, 10.0, 12.8, and 17.9%, respectively. After adjusting for potential confounders, admission serum phosphate > 4.4 mg/dl was associated with an increased risk of developing AKI with an odds ratio of 1.72 (95% confidence interval 1.20-2.47), whereas admission serum phosphate levels < 4.4 mg/dl were not associated with development of AKI during hospitalization. CONCLUSION Elevated admission phosphate is associated with an increased risk for in-hospital AKI.
Collapse
|
123
|
Salleck D, John S. [Cardiorenal syndrome]. Med Klin Intensivmed Notfmed 2017; 114:439-443. [PMID: 28905081 DOI: 10.1007/s00063-017-0346-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/11/2017] [Accepted: 07/29/2017] [Indexed: 11/29/2022]
Abstract
Patients in the intensive care unit often suffer from cardiorenal syndrome, which can have an important influence on the patient's outcome. The heart and kidney influence each other via organ crosstalk. We screened and evaluated current publications on cardiorenal syndromes and their therapy. A key role in the management of cardiorenal syndromes is renal decongestion via loop diuretics.
Collapse
Affiliation(s)
- D Salleck
- Interdisziplinäre Intensivmedizin, Universitätsklinik Medizinische Klinik 8 - Kardiologie, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg Süd, Breslauer Straße 201, 90471, Nürnberg, Deutschland
| | - S John
- Interdisziplinäre Intensivmedizin, Universitätsklinik Medizinische Klinik 8 - Kardiologie, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg Süd, Breslauer Straße 201, 90471, Nürnberg, Deutschland.
| |
Collapse
|
124
|
Yalçınkaya Yavuz Ö, Aydoğdu N, Taştekin E, Süt N. The Effects of Baicalin on Myoglobinuric Acute Renal Failure in Rats. Balkan Med J 2017; 35:68-76. [PMID: 28903885 PMCID: PMC5820450 DOI: 10.4274/balkanmedj.2017.0040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Myoglobinuric acute kidney injury is a uremic syndrome that develops due to damage of skeletal muscle. Free radicals and nitric oxide play an important role in the pathogenesis of myoglobinuric acute kidney injury. Baicalin has multiple bioactivities, including antimicrobial, anti-inflammatory and antioxidant properties and is a potent free radical scavenger. Aims: To investigate the nephroprotective mechanism of baicalin on myoglobinuric acute kidney injury. Study Design: Animal experimentation. Methods: In our study, male Sprague Dawley rats were divided into 4 groups. Control (n=8), Baicalin (n=8), myoglobinuric acute kidney injury (n=10) and myoglobinuric acute kidney injury + baicalin (n=10). The rats were deprived of water for 24 hours before receiving intramuscular injection. The control and baicalin groups were injected intramuscularly with saline (8 ml/kg), and the myoglobinuric acute kidney injury and myoglobinuric acute kidney injury + baicalin groups were given 50% glycerol 8 ml/kg. One hour later, the control and myoglobinuric acute kidney injury groups received saline intraperitoneally, and the baicalin and myoglobinuric acute kidney injury + baicalin groups were given 200 mg/kg baicalin. Twenty-four hours after the glycerol injection, urine and blood samples were taken, and the kidneys of the rats were harvested under intraperitoneally injections of anaesthesia. Results: We found that the levels of creatinine, urea, nitric oxide, alanine transaminase, aspartate aminotransferase, creatine kinase in serum samples, malondialdehyde, nitric oxide, inducible nitric oxide synthase, and endothelial nitric oxide synthase concentrations in renal tissue were increased in the myoglobinuric acute kidney injury group compared with the control group (p<0.05). The nitric oxide and glutathione levels in the kidney were significantly decreased in the myoglobinuric acute kidney injury + baicalin group compared with the myoglobinuric acute kidney injury group (p<0.05). There were no significant differences between any other parameters. Conclusion: Our results did not show any protective effect of baicalin on myoglobinuric acute kidney injury, possibly because the different effective factors in the pathogenesis of experimental myoglobinuric acute kidney injury used in this experiment deviate from other experimental models. Moreover, detailed studies are needed to clarify the effects of baicalin in different doses and treatment durations in glycerol-induced acute kidney injury model.
Collapse
Affiliation(s)
| | - Nurettin Aydoğdu
- Department of Physiology, Trakya University School of Medicine, Edirne, Turkey
| | - Ebru Taştekin
- Department of Pathology, Trakya University School of Medicine, Edirne, Turkey
| | - Necdet Süt
- Department of Biostatistics, Trakya University School of Medicine, Edirne, Turkey
| |
Collapse
|
125
|
Vikrant S, Parashar A. Two Cases of Acute Kidney Injury Due to Multiple Wasp Stings. Wilderness Environ Med 2017; 28:249-252. [DOI: 10.1016/j.wem.2017.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 05/17/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
|
126
|
Effect of curcumin on glycerol-induced acute kidney injury in rats. Sci Rep 2017; 7:10114. [PMID: 28860665 PMCID: PMC5579036 DOI: 10.1038/s41598-017-10693-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/14/2017] [Indexed: 12/11/2022] Open
Abstract
The aim of this study was to investigate the protective role and underlying mechanisms of curcumin on glycerol-induced acute kidney injury (AKI) in rats. Glycerol (10 ml/kg BW, 50% v/v in sterile saline, i.m.) was used to induce AKI, followed by curcumin (200 mg/kg/day, p.o.) administration for 3 days. To confirm renal damage and the effects of curcumin on AKI, serum BUN, Scr, and CK as well as renal SOD, MDA, GSH-Px were measured. Additionally, morphological changes were identified by H&E staining and transmission electron microscopy. The expression of several factors including chemotactic factor MCP-1, proinflammatory cytokines including TNF-α and IL-6, as well as the kidney injury markers, as Kim-1 and Lipocalin-2 were also assessed using q-PCR. Finally, cell apoptosis in renal tissue was detected using in situ TUNEL apoptosis fluorescence staining and expression of proteins associated with apoptotic, oxidative stress and lipid oxidative related signaling pathways were detected using immunohistochemical staining and western blot. The results showed that curcumin exerts renoprotective effects by inhibiting oxidative stress in rhabdomyolysis-induced AKI through regulation of the AMPK and Nrf2/HO-1 signaling pathways, and also ameliorated RM-associated renal injury and cell apoptosis by activating the PI3K/Akt pathway.
Collapse
|
127
|
Li M, Xu L, Feng G, Zhang Y, Wang X, Wang Y. High glucose downregulates myocardin expression in rat glomerular mesangial cells via the ERK signaling pathway. Oncotarget 2017; 8:87390-87400. [PMID: 29152089 PMCID: PMC5675641 DOI: 10.18632/oncotarget.20498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 07/26/2017] [Indexed: 01/26/2023] Open
Abstract
Mesangial cells (MCs), which are vascular smooth muscle-derived cells, occupy the central position in the glomerulus. Diabetic nephropathy (DN) is one of the most common diabetes complications and is likely attributed to the loss of MC contractility. Myocardin stimulates downstream vascular smooth muscle genes and regulates the contractility of vascular smooth muscle cells. Therefore, we hypothesized that myocardin is expressed in MCs and that high glucose is involved in the regulation of myocardin and downstream contractile genes in the context of DN. Confocal microscopy revealed that myocardin is expressed in rat MCs. Western blot and RT-qPCR analyses showed that treatment with 30 mM D-glucose significantly downregulated the mRNA and protein levels of myocardin and downstream SM α-actin. As an isotonic contrast, 30 mM mannitol did not affect myocardin mRNA levels but did downregulate myocardin protein levels. Treatment with 30 mM mannitol also downregulated SM α-actin mRNA and protein levels. Conversely, as another isotonic contrast, 30 mM L-glucose also had no effect on myocardin and SM α-actin expression in MCs. The extracellular signal-regulated kinase (ERK) pathway was activated by treatment with 30 mM D-glucose or mannitol, while specific inhibitors of the ERK pathway (PD98059) compromised the downregulation of myocardin and SM α-actin triggered by high glucose or mannitol. Thus we revealed that myocardin is expressed in MCs and that high glucose downregulates myocardin expression and downstream contractile protein SM α-actin via the ERK pathway. Our results suggest a novel mechanism for high glucose inhibition of MC contraction, which contributes to DN pathogenesis.
Collapse
Affiliation(s)
- Ming Li
- School of Basic Medical Sciences, Hebei University, Baoding, China.,Department of Biochemistry, School of Medicine, Nankai University, Tianjin, China
| | - Lijuan Xu
- Department of Biochemistry, School of Medicine, Nankai University, Tianjin, China
| | - Guowei Feng
- Department of Genitourinary Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yan Zhang
- Department of Biochemistry, School of Medicine, Nankai University, Tianjin, China
| | - Xin Wang
- Department of Biochemistry, School of Medicine, Nankai University, Tianjin, China
| | - Yuebing Wang
- Department of Biochemistry, School of Medicine, Nankai University, Tianjin, China
| |
Collapse
|
128
|
Nguyen TC, Garcia B, Fisher K, Patterson D, Hamza A. Rhabdomyolysis as a rare paraneoplastic presentation of acute myeloid leukemia. Oxf Med Case Reports 2017; 2017:omx033. [PMID: 28694972 PMCID: PMC5497510 DOI: 10.1093/omcr/omx033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/01/2017] [Accepted: 05/09/2017] [Indexed: 11/14/2022] Open
Abstract
We present the case of a 56-year-old man who presented with rhabdomyolysis and was found to have acute myeloid leukemia (AML). Our case is the first to show an association of rhabdomyolysis with AML. Although rhabdomyolysis is likely a very rare clinical presentation of AML, our case raises awareness for workup for AML in patients who present with rhabdomyolysis and other suspicious findings. Both conditions are medical emergencies and require immediate treatment.
Collapse
Affiliation(s)
- Thu-Cuc Nguyen
- Department of Internal Medicine, University of Central Florida, Orlando, FL, USA.,Ocala Health, Ocala, FL, USA
| | - Berenice Garcia
- Department of Internal Medicine, University of Central Florida, Orlando, FL, USA.,Ocala Health, Ocala, FL, USA
| | | | | | - Alan Hamza
- Department of Internal Medicine, University of Central Florida, Orlando, FL, USA.,Ocala Health, Ocala, FL, USA
| |
Collapse
|
129
|
Moggio A, Geraci S, Boido A, Sticht C, Gretz N, Bussolati B. Assessment of acute kidney injury in rhabdomyolytic mice by transcutaneous measurement of sinistrin excretion. Nephrol Dial Transplant 2017; 32:1167-1175. [DOI: 10.1093/ndt/gfw438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
|
130
|
McKay BD, Yeo NM, Jenkins NDM, Miramonti AA, Cramer JT. Exertional Rhabdomyolysis in a 21-Year-Old Healthy Woman: A Case Report. J Strength Cond Res 2017; 31:1403-1410. [PMID: 28146033 DOI: 10.1519/jsc.0000000000001824] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
McKay, BD, Yeo, NM, Jenkins, NDM, Miramonti, AA, and Cramer, JT. Exertional rhabdomyolysis in a 21-year-old healthy woman: a case report. J Strength Cond Res 31(5): 1403-1410, 2017-The optimal resistance training program to elicit muscle hypertrophy has been recently debated and researched. Although 3 sets of 10 repetitions at 70-80% of the 1 repetition maximum (1RM) are widely recommended, recent studies have shown that low-load (∼30% 1RM) high-repetition (3 sets of 30-40 repetitions) resistance training can elicit similar muscular hypertrophy. Incidentally, this type of resistance training has gained popularity. In the process of testing this hypothesis in a research study in our laboratory, a subject was diagnosed with exertional rhabdomyolysis after completing a resistance training session that involved 3 sets to failure at 30% 1RM. Reviewed were the events leading up to and throughout the diagnosis of exertional rhabdomyolysis in a healthy recreationally-trained 21-year-old woman who was enrolled in a study that compared the acute effects of high-load low-repetition vs. low-load high-repetition resistance training. The subject completed a total of 143 repetitions of the bilateral dumbbell biceps curl exercise. Three days after exercise, she reported excessive muscle soreness and swelling and sought medical attention. She was briefly hospitalized and then discharged with instructions to take acetaminophen for soreness, drink plenty of water, rest, and monitor her creatine kinase (CK) concentrations. Changes in the subject's CK concentrations, ultrasound-determined muscle thickness, and echo intensity monitored over a 14-day period are reported. This case illustrates the potential risk of developing exertional rhabdomyolysis after a low-load high-repetition resistance training session in healthy, young, recreationally-trained women. The fact that exertional rhabdomyolysis is a possible outcome may warrant caution when prescribing this type of resistance exercise.
Collapse
Affiliation(s)
- Brianna D McKay
- 1Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska; and 2Department of Health and Human Performance, Oklahoma State University, Stillwater, Oklahoma
| | | | | | | | | |
Collapse
|
131
|
Silva GBD, Vasconcelos AG, Rocha AMT, Vasconcelos VRD, Barros JD, Fujishima JS, Ferreira NB, Barros EJG, Daher EDF. Acute kidney injury complicating bee stings - a review. Rev Inst Med Trop Sao Paulo 2017; 59:e25. [PMID: 28591253 PMCID: PMC5459532 DOI: 10.1590/s1678-9946201759025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/31/2017] [Indexed: 11/21/2022] Open
Abstract
Bee stings can cause severe reactions and have caused many victims in the last
years. Allergic reactions can be triggered by a single sting and the greater the
number of stings, the worse the prognosis. The poisoning effects can be systemic
and can eventually cause death. The poison components are melitin, apamin,
peptide 401, phospholipase A2, hyaluronidase, histamine, dopamine, and
norepinephrine, with melitin being the main lethal component. Acute kidney
injury (AKI) can be observed in patients suffering from bee stings and this is
due to multiple factors, such as intravascular hemolysis, rhabdomyolysis,
hypotension and direct toxicity of the venom components to the renal tubules.
Arterial hypotension plays an important role in this type of AKI, leading to
ischemic renal lesion. The most commonly identified biopsy finding in these
cases is acute tubular necrosis, which can occur due to both, ischemic injury
and the nephrotoxicity of venom components. Hemolysis and rhabdomyolysis
reported in many cases in the literature, were demonstrated by elevated serum
levels of indirect bilirubin and creatine kinase. The severity of AKI seems to
be associated with the number of stings, since creatinine levels were higher, in
most cases, when there were more than 1,000 stings. The aim of this study is to
present an updated review of AKI associated with bee stings, including the
currently advised clinical approach.
Collapse
Affiliation(s)
- Geraldo Bezerra da Silva
- Universidade de Fortaleza, Faculdade de Medicina, Centro de Ciências da Saúde, Fortaleza, Ceará, Brazil
| | - Adolfo Gomes Vasconcelos
- Universidade de Fortaleza, Faculdade de Medicina, Centro de Ciências da Saúde, Fortaleza, Ceará, Brazil
| | - Amanda Maria Timbó Rocha
- Universidade de Fortaleza, Faculdade de Medicina, Centro de Ciências da Saúde, Fortaleza, Ceará, Brazil
| | | | - João de Barros
- Universidade Federal do Amapá, Hospital de Clínicas Dr. Alberto Lima, Macapá, Amapá, Brazil
| | | | | | - Elvino José Guardão Barros
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Elizabeth De Francesco Daher
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Medicina Clínica, Fortaleza, Ceará, Brazil
| |
Collapse
|
132
|
Multimodality imaging findings in rhabdomyolysis and a brief review of differential diagnoses. Emerg Radiol 2017; 24:387-392. [PMID: 28497405 DOI: 10.1007/s10140-017-1512-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 04/28/2017] [Indexed: 01/06/2023]
Abstract
Rhabdomyolysis has traditionally been a clinical diagnosis with healthcare providers utilizing historical context, physical exam, and laboratory data to arrive at a diagnosis. However, there are myriad imaging findings that may be corroborative and support the presumptive diagnosis. This paper seeks to review imaging findings associated with rhabdomyolysis using different modalities including radiography, sonography, computed tomography (CT), magnetic resonance imaging (MRI), and bone scintigraphy.
Collapse
|
133
|
Choy K, Holgate S, Delmenico L, McVeigh M, Friedman D. Rhabdomyolysis: review of cases over a decade at a regional teaching hospital. Intern Med J 2017. [DOI: 10.1111/imj.5_13461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- K Choy
- Department of General Medicine; University Hospital Geelong, Barwon Health; Barwon Health Geelong Victoria Australia
| | - S Holgate
- Department of General Medicine; University Hospital Geelong, Barwon Health; Barwon Health Geelong Victoria Australia
| | - L Delmenico
- Department of General Medicine; University Hospital Geelong, Barwon Health; Barwon Health Geelong Victoria Australia
| | - M McVeigh
- Department of General Medicine; University Hospital Geelong, Barwon Health; Barwon Health Geelong Victoria Australia
| | - D Friedman
- Department of General Medicine; University Hospital Geelong, Barwon Health; Barwon Health Geelong Victoria Australia
| |
Collapse
|
134
|
Evaluation of vascular tone and cardiac contractility in response to silver nanoparticles, using Langendorff rat heart preparation. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2017; 13:1507-1518. [DOI: 10.1016/j.nano.2017.01.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/24/2017] [Accepted: 01/30/2017] [Indexed: 11/20/2022]
|
135
|
Wang S, Zhang C, Li J, Niyazi S, Zheng L, Xu M, Rong R, Yang C, Zhu T. Erythropoietin protects against rhabdomyolysis-induced acute kidney injury by modulating macrophage polarization. Cell Death Dis 2017; 8:e2725. [PMID: 28383559 PMCID: PMC5477572 DOI: 10.1038/cddis.2017.104] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/02/2017] [Accepted: 02/15/2017] [Indexed: 12/15/2022]
Abstract
Erythropoietin (EPO) is a well-known hormone that is clinically used for the treatment of anemia. Very recently, an increasing body of evidence showed that EPO could still regulate bioactivities of macrophages. However, the details about the immunomodulatory effect of EPO on macrophages are not fully delineated, particularly in the setting of renal damages. Therefore, in the present study, we determined whether EPO could exert an impact on the dynamics of macrophages in a well-established model of rhabdomyolysis-induced acute kidney injury and explored the potential mechanisms. EPO was found to ameliorate kidney injuries by reducing macrophages recruitment and promoting phenotype switch toward M2 macrophages in vivo. It was also confirmed that EPO could directly suppress pro-inflammatory responses of M1 macrophages and promote M2 marker expression in vitro. Data indicated the possible involvement of Jak2/STAT3/STAT6 pathway in the augmentation of EPO on M2 polarization. These results improved the understanding of the immunoregulatory capacity of EPO on macrophages, which might optimize the therapeutic modalities of EPO.
Collapse
Affiliation(s)
- Shuo Wang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Chao Zhang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Jiawei Li
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Sidikejiang Niyazi
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Long Zheng
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Ming Xu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Ruiming Rong
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China.,Department of Transfusion, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cheng Yang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Tongyu Zhu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China.,Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| |
Collapse
|
136
|
Vikrant S, Parashar A. Acute kidney injury due to multiple Hymenoptera stings-a clinicopathological study. Clin Kidney J 2017; 10:532-538. [PMID: 29340149 PMCID: PMC5761506 DOI: 10.1093/ckj/sfx010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/20/2017] [Indexed: 11/14/2022] Open
Abstract
Background Acute kidney injury (AKI) after multiple Hymenoptera stings is well known but still a rare phenomenon. Methods We conducted a retrospective study of the clinicopathological spectrum of AKI due to multiple Hymenoptera stings over 13 years (July 2003-June 2016). Results A total of 35 patients were diagnosed with AKI due to multiple Hymenoptera stings. The mean age of the patients was 44.7 ± 17.4 years and the majority (60%) were men. Haematological and biochemical laboratory abnormalities included anaemia (97.1%), leucocytosis (54.3%), hyperkalaemia (68.6%), severe metabolic acidosis (51.4%), hepatic dysfunction (74.3%), haemolysis (91.4%) and rhabdomyolysis (62.9%). The main complications included acute respiratory distress syndrome (ARDS) and encephalopathy in four (11.4%) patients each; gastrointestinal bleeding, hypertension and panniculitis in two (5.7%) patients each and one (2.9%) patient each developed intra-abdominal bleeding, stroke and polyserositis. Twenty-nine (83%) patients required dialysis. Ten (29%) patients died. A higher white blood cell count (P = 0.05) and the complications of ARDS (P = 0.004) and encephalopathy (P = 0.004) were associated with mortality. The kidney functions normalized at 5.5 ± 2.6 weeks in patients who survived. Kidney biopsy was done in 13 patients. The predominant lesion was acute tubular necrosis (ATN) with or without pigmented granular cast in 10 (77%) patients. In four (30.8%) patients, the kidney biopsy showed severe ATN and in the other six (46.2%), the kidney biopsy showed features of ATN associated with mild to moderate acute interstitial nephritis (AIN). In three (23%) patients the histopathological examination revealed only moderate AIN and these patients were treated with a short course of steroids. Conclusions AKI due to multiple Hymenoptera stings is severe and is associated with high mortality. On renal histology, ATN and AIN are common.
Collapse
Affiliation(s)
- Sanjay Vikrant
- Department of Nephrology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Anupam Parashar
- Community Medicine, Indira Gandhi Medial College, Shimla, Himachal Pradesh, India
| |
Collapse
|
137
|
|
138
|
Maximum Time-to-Rescue After the 1908 Messina-Reggio Calabria Earthquake was 20 Days: Hints for Disaster Planning? Prehosp Disaster Med 2017; 32:249-252. [PMID: 28219457 DOI: 10.1017/s1049023x17000024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Introduction Maximum time-to-rescue has been studied accurately for many earthquakes in the years 1985-2004. No study is available for historical quakes. Hypothesis/Problem This study aimed to evaluate long-term survivors (from the fifth day after the quake) of the Messina-Reggio Calabria earthquake (1908; Italy), which is considered, historically, to be the worst seismic event in Europe. METHODS Accurate readings of 11 national newspapers from the fifth day after the quake looking for rescued persons and transferring, to an ad hoc form, all data relating to each rescued person. RESULTS The maximum time-to rescue was 20 days. There were 225 survivors, among them 51 children (22.6 %). For 23 out 225 rescued persons, there was evidence of availability of foods and drinkable fluids while under the rubble. CONCLUSION The maximum time-to-rescue under the debris following this historical earthquake far exceeds that of all other quakes that occurred in the years 1985-2004. The long survival under debris was probably due to the lack of an order to stop search and rescue. Recent strategies reducing the time for search and rescue carry the risk of missing survivors. De Santo NG , Bisaccia C , De Santo LS . Maximum time-to-rescue after the 1908 Messina-Reggio Calabria Earthquake was 20 days: hints for disaster planning? Prehosp Disaster Med. 2017;32(3):249-252.
Collapse
|
139
|
Mulay SR, Anders HJ. Crystal nephropathies: mechanisms of crystal-induced kidney injury. Nat Rev Nephrol 2017; 13:226-240. [DOI: 10.1038/nrneph.2017.10] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
140
|
Yeon EK, Ryu KN, Kang HJ, Yoon SH, Park SY, Park JS, Jin W. Characteristic MR image finding of squatting exercise-induced rhabdomyolysis of the thigh muscles. Br J Radiol 2017; 90:20160740. [PMID: 28181821 DOI: 10.1259/bjr.20160740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To describe the characteristic MRI appearance of squatting-induced rhabdomyolysis involving the thigh muscles. METHODS This study consisted of 10 cases obtained at 3 institutions from 2005 to 2015. A retrospective review was performed to obtain clinical information and MR scans for rhabdomyolysis of the thigh muscles. MRI was analyzed according to the distribution and degree of muscle involvement; the degree was assessed and graded as normal, mild or prominent. RESULTS The mean patient age was 20.2 years (range, 15-24 years), and 7 of the 10 patients were male. All patients had history of excessive squatting action, suffered clinically from bilateral thigh pain and were confirmed to have rhabdomyolysis through analysis of serum creatine kinase (CK) levels. All of the patients (10/10) exhibited diffuse mild to prominent degree involvement of the anterior thigh muscles according to fluid-sensitive MR sequences. Among the anterior thigh muscles, the rectus femoris was spared in 8 patients (8/10) and mild degree involved in 2 patients (2/10). Thus, no cases exhibited prominent degree involvement of the rectus femoris muscle. CONCLUSION Preservation of the rectus femoris muscle on MRI in squatting-induced rhabdomyolysis may be useful for differentiating rhabdomyolysis from other aetiologies. Advances in knowledge: Preservation of rectus femoris on MRI is distinguishable finding in squatting-induced rhabdomyolysis and reflects the functional anatomy of anterior thigh muscles.
Collapse
Affiliation(s)
- Eung K Yeon
- 1 Department of Medicine, Graduate School, Kyung Hee University, Dongdaemun-ku, Seoul, Republic of Korea
| | - Kyung N Ryu
- 2 Department of Radiology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Dongdaemun-ku, Seoul, Republic of Korea
| | - Hye J Kang
- 2 Department of Radiology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Dongdaemun-ku, Seoul, Republic of Korea
| | - So H Yoon
- 4 Department of Radiology, National Police Hospital, Songpa-gu, Seoul, Republic of Korea
| | - So Y Park
- 3 Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Gangdong-gu, Seoul, Republic of Korea
| | - Ji S Park
- 2 Department of Radiology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Dongdaemun-ku, Seoul, Republic of Korea
| | - Wook Jin
- 3 Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Gangdong-gu, Seoul, Republic of Korea
| |
Collapse
|
141
|
Vikrant S, Parashar A. Snake Bite-Induced Acute Kidney Injury: Report of a Successful Outcome During Pregnancy. Am J Trop Med Hyg 2017; 96:885-886. [PMID: 28167587 DOI: 10.4269/ajtmh.17-0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AbstractSnake bite is an important health hazard in tropics. Snake envenomation in pregnancy may cause fetal death and maternal mortality or morbidity. However, little is known about the toxic effects and optimal management during pregnancy after snake envenomation because of the rarity of cases. Herein, we report a case of a pregnant woman who was successfully treated for snake bite-induced acute kidney injury during the third trimester. She was treated with equine-derived polyvalent anti-snake venom without development of any adverse effects, hemodialysis, and supportive therapy. She fully recovered and subsequently gave birth to a healthy child.
Collapse
Affiliation(s)
- Sanjay Vikrant
- Department of Nephrology, Indira Gandhi Medical College, Shimla, India
| | - Anupam Parashar
- Department of Community Medicine, Indira Gandhi Medical College, Shimla, India
| |
Collapse
|
142
|
Abstract
Rhabdomyolysis, which is a characteristic occurrence in associated with muscle cell necrosis, develops due to various causes. We herein report a rare case of a patient with rhabdomyolysis after high intensity resistance training, in which markedly elevated levels of serum creatine kinase (CK) and urine myoglobin were observed. A previously healthy 37-year-old man presented with severe myalgia and dark urine after performing high-intensity exercise. The patient's serum CK level was 95,100 U/L and his urine myoglobin level was 160,000 ng/mL. His symptoms and laboratory findings gradually improved with the intravenous administration of saline and no complications (including electrolyte imbalance and acute renal failure) developed.
Collapse
Affiliation(s)
- Sakiko Honda
- Department of Cardiology, Matsushita Memorial Hospital, Japan
| | | | | | | |
Collapse
|
143
|
Tsai JP, Lee CJ, Subeq YM, Lee RP, Hsu BG. Acute Alcohol Intoxication Exacerbates Rhabdomyolysis-Induced Acute Renal Failure in Rats. Int J Med Sci 2017; 14:680-689. [PMID: 28824301 PMCID: PMC5562120 DOI: 10.7150/ijms.19479] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/20/2017] [Indexed: 12/19/2022] Open
Abstract
Traumatic and nontraumatic rhabdomyolysis can lead to acute renal failure (ARF), and acute alcohol intoxication can lead to multiple abnormalities of the renal tubules. We examined the effect of acute alcohol intoxication in a rat model of rhabdomyolysis and ARF. Intravenous injections of 5 g/kg ethanol were given to rats over 3 h, followed by glycerol-induced rhabdomyolysis. Biochemical parameters, including blood urea nitrogen (BUN), creatinine (Cre), glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), and creatine phosphokinase (CPK), were measured before and after induction of rhabdomyolysis. Renal tissue injury score, renal tubular cell expression of E-cadherin, nuclear factor-κB (NF-κB), and inducible nitric oxide synthase (iNOS) were determined. Relative to rats in the vehicle group, rats in the glycerol-induced rhabdomyolysis group had significantly increased serum levels of BUN, Cre, GOT, GPT, and CPK, elevated renal tissue injury scores, increased expression of NF-κB and iNOS, and decreased expression of E-cadherin. Ethanol exacerbated all of these pathological responses. Our results suggest that acute alcohol intoxication exacerbates rhabdomyolysis-induced ARF through its pro-oxidant and inflammatory effects.
Collapse
Affiliation(s)
- Jen-Pi Tsai
- Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chung-Jen Lee
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Yi-Maun Subeq
- Department of Nursing, Tzu Chi University, Hualien, Taiwan
| | - Ru-Ping Lee
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Bang-Gee Hsu
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Nephrology, Tzu Chi General Hospital, Hualien, Taiwan
| |
Collapse
|
144
|
Raju NA, Rao SV, Joel JC, Jacob GG, Anil AK, Gowri SM, Kandasamy S. Predictive Value of Serum Myoglobin and Creatine Phosphokinase for Development of Acute Kidney Injury in Traumatic Rhabdomyolysis. Indian J Crit Care Med 2017; 21:852-856. [PMID: 29307967 PMCID: PMC5752795 DOI: 10.4103/ijccm.ijccm_186_17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction: Rhabdomyolysis (RM) is a condition where there is injury to striated muscle fibers causing release of myoglobin, creatine phosphokinase (CPK), and other intracellular contents into the circulation. High myoglobin levels cause acute kidney injury (AKI). Trauma is the most common cause of RM and development of complications related to the degree of myoglobin released. Currently, the degree of RM is assessed and treatment is instituted based on serum CPK. As myoglobin is the direct cause of AKI, we set out to determine if serum myoglobin is a more reliable predictor than CPK for the development of AKI in traumatic RM. Methodology: A prospective observational study of 90 patients was admitted to the surgical Intensive Care Unit/high dependency unit of a tertiary hospital with traumatic RM whose serum CPK >5000 U/L. Along with standard treatment including intravascular volume optimization and hemodynamic stabilization, they were treated with “crush protocol.” Daily/twice a day, serum CPK and myoglobin were estimated. Categorical data are expressed as frequency and percentage, and the continuous variables are presented as mean (standard deviation) or median (interquartile range) based on normality. Other statistical analyses were done using the Chi-square test, independent t-test, and rank sum test based on normality. Results: Fourteen out of 90 patients developed AKI and one patient required renal replacement therapy. CPK value of >12,000 U/l was identified to have 64% sensitivity and 56% specificity for developing AKI whereas serum myoglobin value of >5000 ng/ml was identified to have 78% sensitivity and 77% specificity for developing AKI. Conclusion: Following traumatic RM, in patients on “crush protocol,” serum myoglobin is a more sensitive and specific test than serum CPK, for predicting AKI.
Collapse
Affiliation(s)
- Nithin Abraham Raju
- Division of Critical Care, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shoma Vinay Rao
- Division of Critical Care, Christian Medical College, Vellore, Tamil Nadu, India
| | - J Chakravarthy Joel
- Department of Anaesthesia, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
| | - Gijoe George Jacob
- Division of Critical Care, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - S Mahasampath Gowri
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Subramani Kandasamy
- Division of Critical Care, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
145
|
Lorberbaum T, Sampson KJ, Woosley RL, Kass RS, Tatonetti NP. An Integrative Data Science Pipeline to Identify Novel Drug Interactions that Prolong the QT Interval. Drug Saf 2016; 39:433-41. [PMID: 26860921 PMCID: PMC4835515 DOI: 10.1007/s40264-016-0393-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction Drug-induced prolongation of the QT interval on the electrocardiogram (long QT syndrome, LQTS) can lead to a potentially fatal ventricular arrhythmia known as torsades de pointes (TdP). Over 40 drugs with both cardiac and non-cardiac indications are associated with increased risk of TdP, but drug–drug interactions contributing to LQTS (QT-DDIs) remain poorly characterized. Traditional methods for mining observational healthcare data are poorly equipped to detect QT-DDI signals due to low reporting numbers and lack of direct evidence for LQTS. Objective We hypothesized that LQTS could be identified latently using an adverse event (AE) fingerprint of more commonly reported AEs. We aimed to generate an integrated data science pipeline that addresses current limitations by identifying latent signals for QT-DDIs in the US FDA’s Adverse Event Reporting System (FAERS) and retrospectively validating these predictions using electrocardiogram data in electronic health records (EHRs). Methods We trained a model to identify an AE fingerprint for risk of TdP for single drugs and applied this model to drug pair data to predict novel DDIs. In the EHR at Columbia University Medical Center, we compared the QTc intervals of patients prescribed the flagged drug pairs with patients prescribed either drug individually. Results We created an AE fingerprint consisting of 13 latently detected side effects. This model significantly outperformed a direct evidence control model in the detection of established interactions (p = 1.62E−3) and significantly enriched for validated QT-DDIs in the EHR (p = 0.01). Of 889 pairs flagged in FAERS, eight novel QT-DDIs were significantly associated with prolonged QTc intervals in the EHR and were not due to co-prescribed medications. Conclusions Latent signal detection in FAERS validated using the EHR presents an automated and data-driven approach for systematically identifying novel QT-DDIs. The high-confidence hypotheses flagged using this method warrant further investigation. Electronic supplementary material The online version of this article (doi:10.1007/s40264-016-0393-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tal Lorberbaum
- Department of Physiology and Cellular Biophysics, Columbia University, New York, NY, USA.,Department of Biomedical Informatics, Columbia University, 622 West 168th St. PH20, New York, NY, 10032, USA.,Departments of Systems Biology and Medicine, Columbia University, New York, NY, USA
| | - Kevin J Sampson
- Department of Pharmacology, Columbia University, New York, NY, USA
| | | | - Robert S Kass
- Department of Pharmacology, Columbia University, New York, NY, USA
| | - Nicholas P Tatonetti
- Department of Biomedical Informatics, Columbia University, 622 West 168th St. PH20, New York, NY, 10032, USA. .,Departments of Systems Biology and Medicine, Columbia University, New York, NY, USA. .,Observational Health Data Science and Informatics, New York, NY, USA.
| |
Collapse
|
146
|
Severe Rhabdomyolysis as Complication of Interaction between Atorvastatin and Fusidic Acid in a Patient in Lifelong Antibiotic Prophylaxis: A Dangerous Combination. Case Rep Med 2016; 2016:4705492. [PMID: 28115938 PMCID: PMC5222999 DOI: 10.1155/2016/4705492] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/13/2016] [Accepted: 12/04/2016] [Indexed: 11/17/2022] Open
Abstract
Atorvastatin and HMG-CoA reductase inhibitors are the most frequently used medication in the world due to very few adverse toxic side effects. One potentially life threatening adverse effect is caused by clinically significant statin induced rhabdomyolysis, either independently or in combination with fusidic acid. The patient in our case who previously had cardiac insufficiency, atrial fibrillation, and thoracic aorta aneurysm and was treated with insertion of an endovascular metallic stent in the aorta is presented in the report. He had an inoperable aortitis with an infected stent and para-aortic abscesses with no identified microorganism. The patient responded well to empirical antibiotic treatment with combination therapy of fusidic acid and moxifloxacin. This treatment was planned as a lifelong prophylactic treatment. The patient had been treated with atorvastatin for several years. He developed severe rhabdomyolysis when he was started on fusidic acid and moxifloxacin. The patient made a fast recovery after termination of treatment with atorvastatin and fusidic acid. We here report a life threatening complication of rhabdomyolysis that physicians must be aware of. This can happen either in atorvastatin monotherapy or as a complication of pharmacokinetic interaction between atorvastatin and fusidic acid.
Collapse
|
147
|
Wesseling C, Aragón A, González M, Weiss I, Glaser J, Rivard CJ, Roncal-Jiménez C, Correa-Rotter R, Johnson RJ. Heat stress, hydration and uric acid: a cross-sectional study in workers of three occupations in a hotspot of Mesoamerican nephropathy in Nicaragua. BMJ Open 2016; 6:e011034. [PMID: 27932336 PMCID: PMC5168614 DOI: 10.1136/bmjopen-2016-011034] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To study Mesoamerican nephropathy (MeN) and its risk factors in three hot occupations. DESIGN Cross-sectional. SETTING Chinandega and León municipalities, a MeN hotspot on the Nicaraguan Pacific coast, January-February 2013. PARTICIPANTS 194 male workers aged 17-39 years: 86 sugarcane cutters, 56 construction workers, 52 small-scale farmers. OUTCOME MEASURES (1) Differences between the three occupational groups in prevalences/levels of socioeconomic, occupational, lifestyle and health risk factors for chronic kidney disease (CKD) and in biomarkers of kidney function and hydration; (2) differences in prevalences/levels of CKD risk factors between workers with reduced estimated glomerular filtration rate (eGFRCKD-EPI <80 mL/min/1.73 m2) and workers with normal kidney function (eGFRCKD-EPI ≥80 mL/min/1.73 m2). RESULTS Sugarcane cutters were more exposed to heat and consumed more fluid on workdays and had less obesity, lower blood sugar, lower blood pressure and a better lipid profile. Reduced eGFR occurred in 16%, 9% and 2% of sugarcane cutters, construction workers and farmers, respectively (trend cane > construction > farming, p=0.003). Significant trends (cane > construction > farming) were also observed for high serum urea nitrogen (blood urea nitrogen (BUN) >20 mg/dL), high serum creatinine (SCr >1.2 mg/dL), low urinary pH (≤5.5) and high BUN/SCr ratio (>20) but not for high urinary specific gravity (≥1.030). Sugarcane cutters also more often had proteinuria and blood and leucocytes in the urine. Workers with eGFR <80 mL/min/1.73 m2 reported a higher intake of water and lower intake of sugary beverages. Serum uric acid levels related strongly and inversely to eGFR levels (adj β -10.4 mL/min/1.73 m2, 95% CI -12.2 to -8.5, p<0.001). No associations were observed for other metabolic risk factors, pesticides, non-steroidal anti-inflammatory drugs or alcohol. Among cane cutters, consumption of electrolyte hydration solution appeared preventive (adj β 8.1 mL/min/1.73 m2, p=0.09). CONCLUSIONS Heat stress, dehydration and kidney dysfunction were most common among sugarcane cutters. Kidney dysfunction also occurred to a lesser extent among construction workers, but hardly at all among small-scale farmers. High serum uric acid was associated with reduced kidney function.
Collapse
Affiliation(s)
- Catharina Wesseling
- Unit of Occupational Medicine, Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden
| | - Aurora Aragón
- Research Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua, León, Nicaragua
| | - Marvin González
- Research Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua, León, Nicaragua
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Jason Glaser
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- La Isla Foundation, Chicago, Illinois, USA
| | - Christopher J Rivard
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado,USA
| | - Carlos Roncal-Jiménez
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado,USA
| | - Ricardo Correa-Rotter
- Department Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado,USA
| |
Collapse
|
148
|
Abstract
BACKGROUND Lamotrigine is an anticonvulsant as well as a mood stabilizer. Apart from its established use in the treatment of epilepsy, there has been an expansion of its use in the treatment of mental disorders. Patients with epilepsy as well as those with mental disorders are at increased risk of deliberate drug overdoses. An evidence base for the safety profile of lamotrigine in overdose is an essential tool for prescribers. The objective of this study was to carry out a narrative synthesis of the existing evidence for the safety profile of lamotrigine in overdose. METHODS A systematic search was conducted of EMBASE (1974 to December 2015), MEDLINE (1946 to December 2015), PsycINFO (1806 to December 2015) and CINAHL (1981 to December 2015) databases. Studies were included in which there was a deliberate or accidental single drug overdose of lamotrigine, with its toxic effects described. Studies that did not involve an overdose were excluded. A narrative synthesis of the described toxic effects was carried out. RESULTS Out of 562 articles identified, 26 studies were included, mainly in the form of case reports and series. The most commonly described toxic effects of lamotrigine were on the central nervous system, specifically seizures, movement disorders and reduced consciousness. Other toxic effects included QTc interval and QRS complex prolongations, hypersensitivity reactions, serotonin syndrome as well as rhabdomyolysis possibly due to seizures and/or agitation. Deaths were recorded in two studies, with cardiovascular and neurological toxic effects described. CONCLUSIONS Even though lamotrigine has been reported to be well tolerated, there is a risk of toxic effects which can be life threatening in overdose. This needs to be borne in mind when prescribing to patients at an increased risk of deliberate drug overdose.
Collapse
Affiliation(s)
| | - Adam Todd
- Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, UK
| | - Andrew Husband
- Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, UK
| | - Joe Reilly
- Professor of Mental Health, School of Medicine, Pharmacy and Health, Wolfson Research Institute, Queen's Campus University Boulevard, Thornaby, Stockton-On-Tees TS17 6BH, UK
| |
Collapse
|
149
|
Laubner G, Mikulevičienė G. A series of cases of rhabdomyolysis after ingestion of Tricholoma equestre. Acta Med Litu 2016; 23:193-197. [PMID: 28356809 PMCID: PMC5287993 DOI: 10.6001/actamedica.v23i3.3385] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Tricholoma equestre (hereinafter – T. equestre) is a common edible fungus that is considered to be toxic under certain conditions. Here, we report four cases of acute poisoning caused by T. equestre, including one lethal outcome in Lithuania between 2004 and 2013. In the severe case, fatigue, nausea without vomiting and muscle pain, profuse sweating without fever, and respiratory insufficiency occurred. Laboratory tests showed an elevation of creatine kinase (CK), aspartate aminotransferase (AST), and alanine aminotransferase (ALT). Although clinical findings and laboratory tests support evidence of rhabdomyolysis, no renal insufficiency was observed. Significance of T. equestre in cardiac changes is feasible but remains unclear.
Collapse
Affiliation(s)
- Gabija Laubner
- Republican Vilnius University Hospital, Centre of Toxicology, Vilnius, Lithuania
| | - Gabija Mikulevičienė
- Republican Vilnius University Hospital, Centre of Toxicology, Vilnius, Lithuania
| |
Collapse
|
150
|
[Mortal poisoning by bee stings in a child: Study of a case observed in the regional hospital of Maradi (Niger)]. ACTA ACUST UNITED AC 2016; 109:325-328. [PMID: 27738911 DOI: 10.1007/s13149-016-0506-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 05/03/2016] [Indexed: 11/26/2022]
Abstract
We report a fatal case due to a massive attack by a swarm of bees in a nine-year-old child. The accident was fatal because of two aggravating factors: the cephalic location and the large number of stings (about 300). Complications were coagulopathy, anemia, hemorrhage, coma, and oligoanuria. Support was symptomatic at a facility second level. The outcome was fatal within 14 days. In view of the encountered difficulties, we recommend to build written protocols for the management of envenomation in any health training reference.
Collapse
|