151
|
Mécanismes et prise en charge de la tubulopathie liée à la rhabdomyolyse. MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-016-1229-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
152
|
Konda VR, Arunachalam R, Eerike M, Rao K R, Radhakrishnan AK, Raghuraman LP, Meti V, Devi S. Nephroprotective effect of ethanolic extract of Azima tetracantha root in glycerol induced acute renal failure in Wistar albino rats. J Tradit Complement Med 2016; 6:347-354. [PMID: 27774418 PMCID: PMC5067843 DOI: 10.1016/j.jtcme.2015.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 04/18/2015] [Accepted: 05/04/2015] [Indexed: 12/29/2022] Open
Abstract
The gravity of the impact of renal failure on human health is well known and as there is no specific pharmacotherapy for renal failure, the current study was undertaken to evaluate the effect of root extract of Azima tetracantha, an ancient medicinal plant used in Siddha and Ayurvedhic systems of medicine. The experiment was done in glycerol-induced acute renal failure in Wistar albino rats. Thirty rats were divided into five groups. Group 1 was given normal saline (10 ml/kg) per oral, group 2 with single dose of hypertonic glycerol (8 ml/kg) by intramuscular injection into the hind limbs, group 3 with glycerol and ethanolic extract of A. tetracantha root (ATR) 250 mg/kg, group 4, glycerol and ATR 500 mg/kg and group 5, 500 mg/kg ATR. Extract was given orally 60 min prior to glycerol injection. 24 h urine output, serum creatinine, blood urea nitrogen, total proteins and albumin were measured for all the groups. Kidneys were examined for histopathological changes. The antioxidant activity of the extract was tested in vitro and in vivo. Rats treated with ATR showed significant improvement in biochemical parameters and histopathological changes compared to glycerol treated group. The protective effect was highly significant at 500 mg/kg. Both in vitro and in vivo assays showed significant antioxidant activity. The in vitro activity was comparable to vitamin-C. The ethanolic extract of ATR has nephroprotective effect in glycerol-induced acute renal failure and the mechanism of action could be the antioxidant effect.
Collapse
Affiliation(s)
- Venugopala Rao Konda
- Department of Pharmacology, Chettinad Hospital & Research Institute, Kelambakkam, Chennai, India
| | - Ruckmani Arunachalam
- Department of Pharmacology, Chettinad Hospital & Research Institute, Kelambakkam, Chennai, India
| | - Madhavi Eerike
- Department of Pharmacology, Chettinad Hospital & Research Institute, Kelambakkam, Chennai, India
| | - Ramesh Rao K
- Department of Pathology, Chettinad Hospital & Research Institute, Kelambakkam, Chennai, India
| | - Arun Kumar Radhakrishnan
- Department of Pharmacology, Chettinad Hospital & Research Institute, Kelambakkam, Chennai, India
| | | | - Vinayak Meti
- Department of Pharmacology, Chettinad Hospital & Research Institute, Kelambakkam, Chennai, India
| | - Sobita Devi
- Central Animal House, Chettinad Hospital & Research Institute, Kelambakkam, Chennai, India
| |
Collapse
|
153
|
Reiter RJ, Mayo JC, Tan DX, Sainz RM, Alatorre-Jimenez M, Qin L. Melatonin as an antioxidant: under promises but over delivers. J Pineal Res 2016; 61:253-78. [PMID: 27500468 DOI: 10.1111/jpi.12360] [Citation(s) in RCA: 994] [Impact Index Per Article: 124.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 08/05/2016] [Indexed: 12/12/2022]
Abstract
Melatonin is uncommonly effective in reducing oxidative stress under a remarkably large number of circumstances. It achieves this action via a variety of means: direct detoxification of reactive oxygen and reactive nitrogen species and indirectly by stimulating antioxidant enzymes while suppressing the activity of pro-oxidant enzymes. In addition to these well-described actions, melatonin also reportedly chelates transition metals, which are involved in the Fenton/Haber-Weiss reactions; in doing so, melatonin reduces the formation of the devastatingly toxic hydroxyl radical resulting in the reduction of oxidative stress. Melatonin's ubiquitous but unequal intracellular distribution, including its high concentrations in mitochondria, likely aid in its capacity to resist oxidative stress and cellular apoptosis. There is credible evidence to suggest that melatonin should be classified as a mitochondria-targeted antioxidant. Melatonin's capacity to prevent oxidative damage and the associated physiological debilitation is well documented in numerous experimental ischemia/reperfusion (hypoxia/reoxygenation) studies especially in the brain (stroke) and in the heart (heart attack). Melatonin, via its antiradical mechanisms, also reduces the toxicity of noxious prescription drugs and of methamphetamine, a drug of abuse. Experimental findings also indicate that melatonin renders treatment-resistant cancers sensitive to various therapeutic agents and may be useful, due to its multiple antioxidant actions, in especially delaying and perhaps treating a variety of age-related diseases and dehumanizing conditions. Melatonin has been effectively used to combat oxidative stress, inflammation and cellular apoptosis and to restore tissue function in a number of human trials; its efficacy supports its more extensive use in a wider variety of human studies. The uncommonly high-safety profile of melatonin also bolsters this conclusion. It is the current feeling of the authors that, in view of the widely diverse beneficial functions that have been reported for melatonin, these may be merely epiphenomena of the more fundamental, yet-to-be identified basic action(s) of this ancient molecule.
Collapse
Affiliation(s)
- Russel J Reiter
- Department of Cellular and Structural Biology, University of Texas Health Science Center, San Antonio, TX, USA.
| | - Juan C Mayo
- Department of Cellular and Structural Biology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Dun-Xian Tan
- Department of Cellular and Structural Biology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Rosa M Sainz
- Department of Cellular and Structural Biology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Moises Alatorre-Jimenez
- Department of Cellular and Structural Biology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Lilian Qin
- Department of Cellular and Structural Biology, University of Texas Health Science Center, San Antonio, TX, USA
| |
Collapse
|
154
|
Hayeri MR, Ziai P, Shehata ML, Teytelboym OM, Huang BK. Soft-Tissue Infections and Their Imaging Mimics: From Cellulitis to Necrotizing Fasciitis. Radiographics 2016; 36:1888-1910. [DOI: 10.1148/rg.2016160068] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
155
|
Kim YJ, Kim HR, Jeon HJ, Ju HJ, Chung S, Choi DE, Lee KW, Na KR. Rhabdomyolysis in a patient taking nebivolol. Kidney Res Clin Pract 2016; 35:182-6. [PMID: 27668163 PMCID: PMC5025462 DOI: 10.1016/j.krcp.2015.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 08/06/2015] [Accepted: 09/14/2015] [Indexed: 01/06/2023] Open
Abstract
β Blockers such as propranolol and labetalol are known to induce toxic myopathy because of their partial β2 adrenoceptor agonistic effect. Nebivolol has the highest β1 receptor affinity among β blockers, and it has never been reported to induce rhabdomyolysis until now. We report a patient who developed rhabdomyolysis after changing medication to nebivolol. A 75-year-old woman was admitted to our hospital because of generalized weakness originating 2 weeks before visiting. Approximately 1 month before her admission, her medication was changed from carvedilol 12.5 mg to nebivolol 5 mg. Over this time span, she had no other lifestyle changes causing rhabdomyolysis. Her blood chemistry and whole body bone scan indicated rhabdomyolysis. We considered newly prescribed nebivolol as a causal agent. She was prescribed carvedilol 12.5 mg, which she was previously taking, instead of nebivolol. She was treated by hydration and urine alkalization. She had fully recovered and was discharged.
Collapse
Affiliation(s)
- Ye Jin Kim
- Renal Division, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Hae Ri Kim
- Renal Division, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Hong Jae Jeon
- Renal Division, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Hyun Jun Ju
- Renal Division, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Sarah Chung
- Renal Division, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Dae Eun Choi
- Renal Division, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Kang Wook Lee
- Renal Division, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Ki Ryang Na
- Renal Division, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| |
Collapse
|
156
|
Kim J, Lee J, Kim S, Ryu HY, Cha KS, Sung DJ. Exercise-induced rhabdomyolysis mechanisms and prevention: A literature review. JOURNAL OF SPORT AND HEALTH SCIENCE 2016; 5:324-333. [PMID: 30356493 PMCID: PMC6188610 DOI: 10.1016/j.jshs.2015.01.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 10/26/2014] [Accepted: 01/26/2015] [Indexed: 05/27/2023]
Abstract
Exercise-induced rhabdomyolysis (exRML), a pathophysiological condition of skeletal muscle cell damage that may cause acute renal failure and in some cases death. Increased Ca2+ level in cells along with functional degradation of cell signaling system and cell matrix have been suggested as the major pathological mechanisms associated with exRML. The onset of exRML may be exhibited in athletes as well as in general population. Previous studies have reported that possible causes of exRML were associated with excessive eccentric contractions in high temperature, abnormal electrolytes balance, and nutritional deficiencies possible genetic defects. However, the underlying mechanisms of exRML have not been clearly established among health professionals or sports medicine personnel. Therefore, we reviewed the possible mechanisms and correlated prevention of exRML, while providing useful and practical information for the athlete and general exercising population.
Collapse
Affiliation(s)
- Jooyoung Kim
- Health and Rehabilitation Major, College of Physical Education, Kookmin University, Seoul 136-702, Republic of Korea
| | - Joohyung Lee
- Health and Rehabilitation Major, College of Physical Education, Kookmin University, Seoul 136-702, Republic of Korea
| | - Sojung Kim
- Department of Physical Education, Global Campus, Kyung Hee University, Suwon 446-701, Republic of Korea
| | - Ho Young Ryu
- Division of Sport Science, College of Science and Technology, Konkuk University, Choong-Ju 380-702, Republic of Korea
| | - Kwang Suk Cha
- Division of Sport Science, College of Science and Technology, Konkuk University, Choong-Ju 380-702, Republic of Korea
| | - Dong Jun Sung
- Division of Sport Science, College of Science and Technology, Konkuk University, Choong-Ju 380-702, Republic of Korea
| |
Collapse
|
157
|
Singh RR, Uraiya D, Kumar A, Tripathi N. Early demographic and clinical predictors of developing acute kidney injury in snake bite patients: A retrospective controlled study from an Indian tertiary care hospital in North Eastern Uttar Pradesh India. Indian J Crit Care Med 2016; 20:404-8. [PMID: 27555694 PMCID: PMC4968062 DOI: 10.4103/0972-5229.186221] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aims: This study was conducted retrospectively to define early demographic and clinical predictors for acute kidney injury (AKI) among snake bite patients at the time of hospital admission. Materials and Methods: We analyzed 138 cases with a poisonous snake bite. Patients were classified into two groups according to the presence and absence of AKI. The data regarding clinical features and demographic profile of these patients were collected from the hospital records in a prestructured pro forma and statistically compared. Results: Of the 138 patients of venomous snake bite, 62 developed AKI (44.92%). Patients who developed AKI were older in age. Moreover, prolonged bite to anti-snake venom (ASV) time had a significant relationship in developing AKI (P < 0.05). Among the clinical features, there was an independent positive association of AKI with abdomen pain, tenderness and vomiting, cellulitis, bleeding tendencies, myalgia, and black or brown urine (P < 0.05). Neurological features were inversely associated with renal involvement. Conclusion: We found that marked abdominal pain, tenderness and vomiting, myalgia, black or brown urine, bite site cellulitis, bleeding tendencies, and prolonged (>2 h) bite to ASV time were significantly associated with the development of AKI in snake bite patients.
Collapse
Affiliation(s)
- R R Singh
- Department of Medicine, Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
| | - Dharmendra Uraiya
- Department of Medicine, Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
| | - Anoop Kumar
- Department of Medicine, Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
| | - Neeraj Tripathi
- Department of Medicine, Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
| |
Collapse
|
158
|
Sierra E, Espinosa de Los Monteros A, Fernández A, Díaz-Delgado J, Suárez-Santana C, Arbelo M, Sierra MA, Herráez P. Muscle Pathology in Free-Ranging Stranded Cetaceans. Vet Pathol 2016; 54:298-311. [PMID: 27538973 DOI: 10.1177/0300985816660747] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Despite the profound impact that skeletal muscle disorders may pose for the daily activities of wild terrestrial and marine mammals, such conditions have been rarely described in cetaceans. In this study, the authors aimed to determine the nature and prevalence of skeletal muscle lesions in small and large odontocetes and mysticetes ( n = 153) from 19 different species. A macroscopic evaluation of the epaxial muscle mass and a histologic examination of the longissimus dorsi muscle were performed in all cases. The only macroscopically evident change was variable degrees of atrophy of the epaxial muscles ( longissimus dorsi, multifidus, spinalis) in emaciated specimens. The histopathological study revealed single or combined morphological changes in 91.5% of the cases. These changes included the following: degenerative lesions (75.2%), muscle atrophy (37.9%), chronic myopathic changes (25.5%), parasitic infestation (9.2%), and myositis (1.9%). The skeletal muscle is easily sampled during a necropsy and provides essential microscopic information that reflects both local and systemic conditions. Thus, skeletal muscle should be systematically sampled, processed, and examined in all stranded cetaceans.
Collapse
Affiliation(s)
- E Sierra
- 1 Department of Veterinary Pathology, Institute for Animal Health, Veterinary School, University of Las Palmas de Gran Canaria, Arucas, Spain
| | - A Espinosa de Los Monteros
- 1 Department of Veterinary Pathology, Institute for Animal Health, Veterinary School, University of Las Palmas de Gran Canaria, Arucas, Spain
| | - A Fernández
- 1 Department of Veterinary Pathology, Institute for Animal Health, Veterinary School, University of Las Palmas de Gran Canaria, Arucas, Spain
| | - J Díaz-Delgado
- 1 Department of Veterinary Pathology, Institute for Animal Health, Veterinary School, University of Las Palmas de Gran Canaria, Arucas, Spain
| | - C Suárez-Santana
- 1 Department of Veterinary Pathology, Institute for Animal Health, Veterinary School, University of Las Palmas de Gran Canaria, Arucas, Spain
| | - M Arbelo
- 1 Department of Veterinary Pathology, Institute for Animal Health, Veterinary School, University of Las Palmas de Gran Canaria, Arucas, Spain
| | - M A Sierra
- 2 Department of Anatomy and Comparative Pathology, Veterinary Faculty, University of Córdoba, Córdoba, Spain
| | - P Herráez
- 1 Department of Veterinary Pathology, Institute for Animal Health, Veterinary School, University of Las Palmas de Gran Canaria, Arucas, Spain
| |
Collapse
|
159
|
Welsink-Karssies MM, Polderman JAW, Nieveen van Dijkum EJ, Preckel B, Schlack WS, Visser G, Hollak CE, Hermanides J. Very Long-Chain Acyl-Coenzyme A Dehydrogenase Deficiency and Perioperative Management in Adult Patients. JIMD Rep 2016; 34:49-54. [PMID: 27518779 DOI: 10.1007/8904_2016_6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/24/2016] [Accepted: 07/07/2016] [Indexed: 01/05/2023] Open
Abstract
Surgery and anesthesia pose a threat to patients with very long-chain acyl-CoA dehydrogenase deficiency (VLCADD), because prolonged fasting, stress, and pain are known risk factors for the induction of metabolic derangement. The optimal perioperative management in these patients is unknown and the use of volatile agents and agents dissolved in fatty acids has been related to postoperative metabolic complications. However, the occurrence of metabolic derangement is multifactorial and depends, amongst others, on the severity of the mutation and residual enzyme activity. Current guidelines suggest avoiding both volatile anesthetics as well as propofol, which seriously limits the options for providing safe anesthesia. Therefore, we reviewed the available literature on the perioperative management of patients with VLCADD. We concluded that the use of some medications, such as volatile anesthetics, in patients with VLCADD might be wrongfully avoided and could in fact prevent metabolic derangement by the adequate suppression of pain and stress during surgery. We will illustrate this with a case report of an adult VLCADD patient undergoing minor surgery. Besides the use of remifentanil, anesthesia was uneventfully maintained with the use of sevoflurane, a volatile agent, and continuous glucose infusion. The patient was monitored with a continuous glucose meter and creatinine kinase measurements.
Collapse
Affiliation(s)
- M M Welsink-Karssies
- Department of Anesthesiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J A W Polderman
- Department of Anesthesiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | | | - B Preckel
- Department of Anesthesiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - W S Schlack
- Department of Anesthesiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - G Visser
- Department of Metabolic Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C E Hollak
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - J Hermanides
- Department of Anesthesiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| |
Collapse
|
160
|
Glaser J, Lemery J, Rajagopalan B, Diaz HF, García-Trabanino R, Taduri G, Madero M, Amarasinghe M, Abraham G, Anutrakulchai S, Jha V, Stenvinkel P, Roncal-Jimenez C, Lanaspa MA, Correa-Rotter R, Sheikh-Hamad D, Burdmann EA, Andres-Hernando A, Milagres T, Weiss I, Kanbay M, Wesseling C, Sánchez-Lozada LG, Johnson RJ. Climate Change and the Emergent Epidemic of CKD from Heat Stress in Rural Communities: The Case for Heat Stress Nephropathy. Clin J Am Soc Nephrol 2016; 11:1472-1483. [PMID: 27151892 PMCID: PMC4974898 DOI: 10.2215/cjn.13841215] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Climate change has led to significant rise of 0.8°C-0.9°C in global mean temperature over the last century and has been linked with significant increases in the frequency and severity of heat waves (extreme heat events). Climate change has also been increasingly connected to detrimental human health. One of the consequences of climate-related extreme heat exposure is dehydration and volume loss, leading to acute mortality from exacerbations of pre-existing chronic disease, as well as from outright heat exhaustion and heat stroke. Recent studies have also shown that recurrent heat exposure with physical exertion and inadequate hydration can lead to CKD that is distinct from that caused by diabetes, hypertension, or GN. Epidemics of CKD consistent with heat stress nephropathy are now occurring across the world. Here, we describe this disease, discuss the locations where it appears to be manifesting, link it with increasing temperatures, and discuss ongoing attempts to prevent the disease. Heat stress nephropathy may represent one of the first epidemics due to global warming. Government, industry, and health policy makers in the impacted regions should place greater emphasis on occupational and community interventions.
Collapse
Affiliation(s)
- Jason Glaser
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
161
|
|
162
|
Cunningham J, Sharma R, Kirzner A, Hwang S, Lefkowitz R, Greenspan D, Shapoval A, Panicek DM. Acute myonecrosis on MRI: etiologies in an oncological cohort and assessment of interobserver variability. Skeletal Radiol 2016; 45:1069-78. [PMID: 27105618 PMCID: PMC4912434 DOI: 10.1007/s00256-016-2389-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 03/27/2016] [Accepted: 04/06/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the etiologies of myonecrosis in oncology patients and to assess interobserver variability in interpreting its MRI features. MATERIALS AND METHODS Pathology records in our tertiary cancer hospital were searched for proven myonecrosis, and MRIs of affected regions in those patients were identified. MRI reports that suggested myonecrosis were also identified. Each MRI was reviewed independently by 2 out of 6 readers to assess anatomical site, size, and signal intensities of muscle changes, and the presence of the previously reported stipple sign (enhancing foci within a region defined by rim enhancement). The stipple sign was assessed again, weeks after a training session. Cohen kappa and percentage agreement were calculated. Medical records were reviewed for contemporaneous causes of myonecrosis. RESULTS MRI reports in 73 patients suggested the diagnosis of myonecrosis; pathological proof was available in another 2. Myonecrosis was frequently associated with radiotherapy (n = 34 patients, 45 %); less frequent causes included intraoperative immobilization, trauma, therapeutic embolization, ablation therapy, exercise, and diabetes. Myonecrosis usually involved the lower extremity, the pelvis, and the upper extremity; mean size was 13.0 cm. The stipple sign was observed in 55-100 % of patients at first assessment (κ = 0.09-0.42; 60-80 % agreement) and 55-100 % at second (κ = 0.0-0.58; 72-90 % agreement). Enhancement surrounded myonecrosis in 55-100 % patients (κ = 0.03-0.32; 58-70 % agreement). CONCLUSION Myonecrosis in oncology patients usually occurred after radiotherapy, and less commonly after intraoperative immobilization, trauma, therapeutic embolization, ablation therapy, exercise, or diabetes. Although interobserver variability for MRI features of myonecrosis exists (even after focused training), a combination of findings facilitates diagnosis and conservative management.
Collapse
Affiliation(s)
- Jane Cunningham
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 1275 York Avenue, New York, NY 10065
| | - Richa Sharma
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 1275 York Avenue, New York, NY 10065
| | - Anna Kirzner
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 1275 York Avenue, New York, NY 10065
| | - Sinchun Hwang
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 1275 York Avenue, New York, NY 10065,Weill Medical College of Cornell University, New York, NY 10065
| | - Robert Lefkowitz
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 1275 York Avenue, New York, NY 10065,Weill Medical College of Cornell University, New York, NY 10065
| | - Daniel Greenspan
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 1275 York Avenue, New York, NY 10065
| | - Anton Shapoval
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 1275 York Avenue, New York, NY 10065
| | - David M. Panicek
- Memorial Sloan Kettering Cancer Center, Department of Radiology, 1275 York Avenue, New York, NY 10065,Weill Medical College of Cornell University, New York, NY 10065
| |
Collapse
|
163
|
Dalbjerg SM, Tsakiri A, Frederiksen JL. Rhabdomyolysis following interferon-beta treatment in a patient with multiple sclerosis – A case report. Mult Scler Relat Disord 2016; 8:93-5. [PMID: 27456881 DOI: 10.1016/j.msard.2016.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/02/2016] [Accepted: 05/04/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Sara Maria Dalbjerg
- Department of Neurology, Glostrup Hospital, University of Copenhagen, Nordre Ringvej 57, 2600 Glostrup, Denmark.
| | - Anna Tsakiri
- Department of Neurology, Glostrup Hospital, University of Copenhagen, Nordre Ringvej 57, 2600 Glostrup, Denmark.
| | - Jette Lautrup Frederiksen
- Department of Neurology, Glostrup Hospital, University of Copenhagen, Nordre Ringvej 57, 2600 Glostrup, Denmark.
| |
Collapse
|
164
|
Ihedioha U, Sinha S, Campbell AC. Do Creatine Kinase (CK) Levels Influence the Diagnosis or Outcome in Patients with Compartment Syndrome? Scott Med J 2016; 50:158-9. [PMID: 16374979 DOI: 10.1177/003693300505000407] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report a retrospective study in patients with compartment syndrome with the aim to analyse: 1) whether the level of rise in CK levels is a useful marker to the presence of compartment syndrome and; 2) whether an early fasciotomy assists in lowering of the elevated CK levels. The results of our study suggest that although raised CK levels are not diagnostic, they are a useful adjunct in making a diagnosis, and hence CK estimation should be done in all patients with suspected compartment syndrome. Moreover, an early fasciotomy (<12 hours) has a statistically significant influence in lowering elevated CK levels, confirming the view that the earlier the decompression, the lesser the muscle damage.
Collapse
Affiliation(s)
- U Ihedioha
- Department of Orthopaedic Surgery, Monklands Hospital, Airdrie
| | | | | |
Collapse
|
165
|
Arslan MN, Melez DO, Akcay A, Gur A, Sam B, Guven Apaydın S. Coincidence of Nicolau Syndrome and Rhabdomyolysis: Report of a Forensic Autopsy Case and Review of the Literature. J Forensic Sci 2016; 61:1369-74. [PMID: 27320825 DOI: 10.1111/1556-4029.13126] [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: 09/19/2015] [Revised: 11/29/2015] [Accepted: 12/05/2015] [Indexed: 01/09/2023]
Abstract
Nicolau syndrome (NS) is a dermatological adverse reaction of intramuscular injections and is caused by several mechanisms. The etiopathogenesis remains unclear, and several hypotheses have suggested a vascular origin. Rhabdomyolysis (RM) is the destruction of striated muscle, with the subsequent release of muscle cell contents into circulation. NS and RM diagnoses may overlap. Herein, we present the autopsy findings of a 40-year-old female with NS complicated with RM. On clinical follow-up, creatine kinase (CK) was 7146 IU/L, and urea and creatinine levels were elevated on the third day after intramuscular diclofenac injection. Possible ischemic process triggered the RM and subsequent acute renal failure. The opportunity for an early diagnosis was missed because the patient delayed seeking medical aid. The prognosis worsened, and the patient died due to secondary sepsis. Early diagnosis of NS before the occurrence of complications is the most important issue in patient education and can be life-saving.
Collapse
Affiliation(s)
- Murat Nihat Arslan
- Council of Forensic Medicine, Cobancesme M. Kimiz Sk. No:1 Bahcelievler 34196 Istanbul, Turkey.
| | - Deniz Oguzhan Melez
- Council of Forensic Medicine, Cobancesme M. Kimiz Sk. No:1 Bahcelievler 34196 Istanbul, Turkey
| | - Arzu Akcay
- Council of Forensic Medicine, Cobancesme M. Kimiz Sk. No:1 Bahcelievler 34196 Istanbul, Turkey
| | - Adem Gur
- Council of Forensic Medicine, Cobancesme M. Kimiz Sk. No:1 Bahcelievler 34196 Istanbul, Turkey
| | - Bulent Sam
- Council of Forensic Medicine, Cobancesme M. Kimiz Sk. No:1 Bahcelievler 34196 Istanbul, Turkey
| | - Suheyla Guven Apaydın
- Haydarpasa Numune Teaching Hospital, Tıbbiye Cad. No:23 Uskudar 34668 Istanbul, Turkey
| |
Collapse
|
166
|
Satirapoj B, Kongthaworn S, Choovichian P, Supasyndh O. Electrolyte disturbances and risk factors of acute kidney injury patients receiving dialysis in exertional heat stroke. BMC Nephrol 2016; 17:55. [PMID: 27267762 PMCID: PMC4895821 DOI: 10.1186/s12882-016-0268-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 06/01/2016] [Indexed: 02/04/2023] Open
Abstract
Background Exertional heat stroke (EHS) is a life-threatening illness and leads to multi-organ dysfunction including acute kidney injury (AKI). The clinical significance of abnormal electrolytes and renal outcomes in ESH patients has been poorly documented. We aim to exhibit the electrolyte abnormalities, renal outcomes and risk factors of patients with AKI receiving dialysis in EHS. Methods A retrospective cohort study in EHS patients between 2003 and 2014 were conducted. Clinical and laboratory outcomes including serum and urine electrolytes, AKI and dialysis were assessed on admission, during hospitalization and at the time of their discharge from the hospital. A logistic regression analysis was performed for risk factors of acute dialysis. Results All 66 subjects with mean age 22.1 ± 4.3 years were included. On admission, the common electrolyte disturbances were hypokalemia (71.2 %), hypophosphatemia (59.1 %), hyponatremia (53.0 %), hypocalcemia (51.5 %), and hypomagnesemia (34.9 %). Electrolytes depletion was confirmed as renal loss (potassium loss; 54.2 %, phosphate loss; 86.7 %, sodium loss; 64.7 % and magnesium loss; 83.3 %). During hospitalization ranging from 2 to 209 days, 90.9 % patients suffered from AKI with 16.7 % receiving acute dialysis, and 3 % patients died. At discharge, AKI and electrolyte abnormalities had dramatically improved. The prognosis factors for AKI receiving dialysis were identified as neurological status, renal function and serum muscle enzyme at time of admission. Conclusion The study suggests that hypoelectrolytemia and AKI are frequently observed in patients with EHS. Neurological impairment, impaired renal function, and increased serum muscle enzyme should be considered risk factors of acute dialysis.
Collapse
Affiliation(s)
- Bancha Satirapoj
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, 315, Bangkok, 10400, Thailand.
| | - Suramanat Kongthaworn
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, 315, Bangkok, 10400, Thailand
| | - Panbubpa Choovichian
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, 315, Bangkok, 10400, Thailand
| | - Ouppatham Supasyndh
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, 315, Bangkok, 10400, Thailand
| |
Collapse
|
167
|
Gibson JL, Nesbitt I, Dinsdale A, Walker H. Survival of ingestion of a potentially lethal dose of caffeine. Br J Hosp Med (Lond) 2016; 77:114-5. [PMID: 26875808 DOI: 10.12968/hmed.2016.77.2.114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jane L Gibson
- Specialist Trainee in Anaesthesia and Intensive Care Medicine in the Department of Anaesthesia and Intensive Care Medicine, Freeman Hospital, Newcastle upon Tyne NE7 7DN
| | - Ian Nesbitt
- Consultant in Anaesthesia and Intensive Care Medicine in the Department of Anaesthesia and Intensive Care Medicine, Freeman Hospital, Newcastle upon Tyne
| | - Amy Dinsdale
- Medical Student in the Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne
| | - Hamish Walker
- Medical Student in the Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne
| |
Collapse
|
168
|
Mozafari N, Talaie H, Shoaei SD, Hashemian M, Mahdavinejad A. Survey on Hypothermia and Hyperthermia in Poisoned Patients in a Unique Referral Hospital, Tehran, Iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e35483. [PMID: 27275403 PMCID: PMC4893414 DOI: 10.5812/ircmj.35483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/13/2016] [Accepted: 02/29/2016] [Indexed: 11/16/2022]
Abstract
Background Body temperature is a critical criterion of health. Drugs and a variety of poisons can affect body temperature in poisoned patients, causing hyperthermia and hyperpyrexia. Objectives Our previous study’s findings in patients poisoned with organophosphate led us to the goal of this study: obtaining the initial tympanic temperature in patients poisoned by a variety of toxins. Materials and Methods A cross-sectional study reviewed the records of poisoned patients who were admitted to the toxicological intensive care unit (TICU) at Loghman Hakim hospital poison center (LHHPC) from February 2014 to February 2015. The data collected included gender, age, type of poisoning, the season during which poisoning occurred, vital signs, initial tympanic temperature (first four hours), presence of seizures, white blood cell (WBC) count, creatinine phosphokinase (CPK), length of stay and patient outcome. We determined the mean (SD) for normally distributed continuous variables, the median and interquartile range for non-normally distributed continuous variables, and the absolute and relative frequency (%) for categorical variables. All were determined using SPSS version 16. Results Data were collected from 310 eligible patients. The mean patient age was 32.65 (with a standard deviation of 14.40). Of the patients in the study, 183 (59%) were male. Intentional poisoning in an attempted suicide was documented in 253 (81.6%) patients. The most prevalent poisoning agent was aluminum phosphate (18.70%), followed by methadone (10%) and opium (10%). Seventy percent of the patients (n = 217) were diagnosed and classified with fever or hyperthermia. A temperature ≥ 40°C was detected in just three cases. The highest mean temperature was found in patients poisoned with amphetamine, organophosphate and tramadol. Patients with alcohol and phenobarbital poisoning were included in the sample, but these patients were not diagnosed with hypothermia. WBC ≥ 10,000 cells/mL and CPK ≥ 975 IU/L were recorded in 57.7% and 13.2% of subjects, respectively. Conclusions Body temperature changes in human poisonings are a matter in need of special attention. A literature review did not reveal any controversy over hypothermia, but poisoning cases exhibit a variety of patterns of fever and hyperthermia. If there are no limits to the diagnosis of fever and hyperthermia, all cases with a poor prognosis which fail to respond to treatment could be categorized as drug-induced hyperthermia. Therefore, a different approach is needed for poisoning cases.
Collapse
Affiliation(s)
- Naser Mozafari
- Plastic Surgery Department, 15 Khordad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Haleh Talaie
- Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Haleh Talaie, Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-9122394067, Fax: +98-2155418175, E-mail:
| | - Simin Dokht Shoaei
- Clinical Research and Development Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Morteza Hashemian
- Department of Anesthesiology and Pain Medicine, Bahonar Hospital, Kerman University of Medical Sciences, Kerman, IR Iran
| | - Arezou Mahdavinejad
- Toxicological Research Center, Department of Clinical Toxicology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| |
Collapse
|
169
|
Zhao W, Huang X, Zhang L, Yang X, Wang L, Chen Y, Wang J, Wu G. Penehyclidine Hydrochloride Pretreatment Ameliorates Rhabdomyolysis-Induced AKI by Activating the Nrf2/HO-1 Pathway and Alleviating [corrected] Endoplasmic Reticulum Stress in Rats. The. PLoS One 2016; 11:e0151158. [PMID: 26987113 PMCID: PMC4795801 DOI: 10.1371/journal.pone.0151158] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 02/24/2016] [Indexed: 12/18/2022] Open
Abstract
Acute kidney injury (AKI) is one of the most severe complications of rhabdomyolysis (RM). The underlying mechanisms and potential preventions need to be investigated. Penehyclidine hydrochloride (PHC) was reported to ameliorate renal ischemia-reperfusion injury, but the effect of PHC on RM-reduced AKI is unknown. In this study, we established a rat model of RM-induced AKI using an intramuscular glycerol injection in the hind limbs. Rats were pretreated with PHC before the glycerol injection, and the heme oxygenase-1 (HO-1) inhibitor ZnPP was introduced to evaluate the effect of HO-1 on RM-induced AKI. PHC pretreatment ameliorated the pathological renal injury and renal dysfunction, and decreased the renal apoptosis rate in RM-induced AKI. PHC significantly up-regulated HO-1 expression, increased HO-1 enzymatic activity and decreased the accumulation of myoglobin in renal tissues. This effect was partly inhibited by ZnPP. PHC pretreatment also effectively up-regulated nuclear factor erythroid 2-related factor 2 (Nrf2) and down-regulated glucose regulated protein 78 (GRP78) and caspase-12 at both the gene and protein levels. These results suggest that the protective effects of PHC pretreatment on RM-induced AKI occur at least in part through activating the Nrf2/HO-1 pathway and alleviating endoplasmic reticulum stress (ERS) in rat renal tissues.
Collapse
Affiliation(s)
- Wei Zhao
- Department of Nephrology, Chinese PLA General Hospital, Beijing, the People’s Republic of China
- Department of Nephrology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province, the People’s Republic of China
| | - XuDong Huang
- Department of Nephrology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province, the People’s Republic of China
| | - LiXia Zhang
- Department of Nephrology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province, the People’s Republic of China
| | - XinJun Yang
- Department of Nephrology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province, the People’s Republic of China
| | - LiHui Wang
- Department of Nephrology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province, the People’s Republic of China
| | - YunShuang Chen
- Department of Nephrology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province, the People’s Republic of China
| | - JingHua Wang
- Department of Nephrology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province, the People’s Republic of China
| | - GuangLi Wu
- Department of Nephrology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province, the People’s Republic of China
- * E-mail:
| |
Collapse
|
170
|
Konda VGR, Eerike M, Raghuraman LP, Rajamanickam MK. Antioxidant and Nephroprotective Activities of Aconitum heterophyllum Root in Glycerol Induced Acute Renal Failure in Rats. J Clin Diagn Res 2016; 10:FF01-2. [PMID: 27134892 DOI: 10.7860/jcdr/2016/10798.7388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 11/27/2014] [Indexed: 01/06/2023]
Abstract
AIM The present study was to evaluate the antioxidant and nephroprotective activities of ethanolic extract of Aconitum heterophyllum root (EEAHR) in glycerol induced acute renal failure (ARF) in Wistar albino rats. MATERIALS AND METHODS In vitro antioxidant activity of EEAHR was assessed using the 2, 2-diphenyl-picrylhydrazyl (DPPH assay), nitric oxide radical scavenging (NO assay), hydrogen peroxide (H2O2 assay) and ferric reducing antioxidant power (FRAP) scavenging activity assays. In vivo study, rats were divided into four groups of six each for assessing the nephroprotective activity. Group-1 received normal saline, group-2 received 50% glycerol (10 ml/kg) alone, group-3 received glycerol and 250 mg/kg of EEAHR and group-4 received glycerol and 500 mg/kg of EEAHR. The renal injury and recovery was measured by serum creatinine, blood urea nitrogen (BUN), total proteins, albumin, urine output and histopathological changes. RESULTS In vitro antioxidant activity of root extract was found to be equal to Vitamin C and in an in vivo study root extract treated animals showed significant attenuation of biochemical parameters and histopathological changes of the kidney compared to glycerol treated group and it was found to be more significant with the extract at 500 mg/kg than 250mg/kg. CONCLUSION The present study revealed that Aconitum heterophyllum root has shown antioxidant and nephroprotective activities.
Collapse
Affiliation(s)
- Venu Gopala Rao Konda
- Assistant Professor, Department of Pharmacology, Chettinad Hospital & Research Institute , Kelambakkam, Chennai, Tamilnadu, India
| | - Madhavi Eerike
- Associate Professor, Department of Pharmacology, Chettinad Hospital & Research Institute , Kelambakkam, Chennai, Tamilnadu, India
| | - Lakshmipathy Prabhu Raghuraman
- Assistant Professor, Department of Pharmacology, Chettinad Hospital & Research Institute , Kelambakkam, Chennai, Tamilnadu, India
| | - Maignana Kumar Rajamanickam
- Assistant Professor, Department of Pharmacology, Chettinad Hospital & Research Institute , Kelambakkam, Chennai, Tamilnadu, India
| |
Collapse
|
171
|
Choi HK, Won EK, Choung SY. Effect of Coenzyme Q10 Supplementation in Statin-Treated Obese Rats. Biomol Ther (Seoul) 2016; 24:171-7. [PMID: 26797109 PMCID: PMC4774498 DOI: 10.4062/biomolther.2015.089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/18/2015] [Accepted: 09/24/2015] [Indexed: 12/24/2022] Open
Abstract
Statins, HMG-CoA reductase inhibitors, are known to cause serious muscle injuries (e.g. myopathy, myositis and rhabdomyolysis), and these adverse effects can be rescued by co-administration of coenzyme Q10 (CoQ10) with statins. The goal of the current research is to assess the efficacy of combined treatment of CoQ10 with Atorvastatin for hyperlipidemia induced by high-fat diet in SD rats. 4-week-old Sprague-Dawley male rats were fed normal diet or high-fat diet for 6 weeks. Then, rats were treated with either Statin or Statin with various dosages of CoQ10 (30, 90 or 270 mg/kg/day, p.o.) for another 6 weeks. Compared to Statin only-treatment, CoQ10 supplementation significantly reduced creatine kinase and aspartate aminotransferase levels in serum which are markers for myopathy. Moreover, CoQ10 supplementation with Statin further reduced total fat, triglycerides, total cholesterol, and low-density lipoprotein-cholesterol. In contrast, the levels of high-density lipoprotein-cholesterol and CoQ10 were increased in the CoQ10 co-treated group. These results indicate that CoQ10 treatment not only reduces the side effects of Statin, but also has an anti-obesity effect. Therefore an intake of supplementary CoQ10 is helpful for solving problem of obese metabolism, so the multiple prescription of CoQ10 makes us think a possibility that can be solved in being contiguous to the obesity problem, a sort of disease of the obese metabolism.
Collapse
Affiliation(s)
- Hye-Kyung Choi
- Department of Preventive Pharmacy and Toxicology, College of Pharmacy, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Eun-Kyung Won
- Department of Preventive Pharmacy and Toxicology, College of Pharmacy, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Se-Young Choung
- Department of Preventive Pharmacy and Toxicology, College of Pharmacy, Kyung Hee University, Seoul 02447, Republic of Korea
| |
Collapse
|
172
|
Jiang W, Wang X, Zhou S. Rhabdomyolysis induced by antiepileptic drugs: characteristics, treatment and prognosis. Expert Opin Drug Saf 2016; 15:357-65. [DOI: 10.1517/14740338.2016.1139572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
173
|
Huang D, Wang C, Meng Q, Liu Z, Huo X, Sun H, Yang S, Ma X, Peng J, Liu K. Protective effects of formononetin against rhabdomyolysis-induced acute kidney injury by upregulating Nrf2 in vivo and in vitro. RSC Adv 2016. [DOI: 10.1039/c6ra20339f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Acute kidney injury (AKI) is a well-known organ injury frequently observed after rhabdomyolysis (RM).
Collapse
|
174
|
Bhakthavatsalam RK, Venu G, Raju PK, Madhusudan HC. White collar rhabdomyolysis with acute kidney injury. Indian J Nephrol 2016; 26:449-451. [PMID: 27942178 PMCID: PMC5131385 DOI: 10.4103/0971-4065.177209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Rhabdomyolysis is a clinical syndrome resulting from the disintegration of muscle cell and spillage of toxic intracellular contents into circulation. Strenuous, unaccustomed exercise leads to exertional rhabdomyolysis and cause AKI. We report a 26-year-old female who developed white collar rhabdomyolysis with AKI after performing sit-ups (Super Yoga Brain) for 108 times in temple. She was managed with hemodialysis and supporting therapy. She made a full recovery after 4 weeks. Awareness of this condition and early diagnosis is highlighted.
Collapse
Affiliation(s)
- R K Bhakthavatsalam
- Department of Nephrology, PSG IMS and R, Peelamedu, Coimbatore, Tamil Nadu, India
| | - G Venu
- Department of Nephrology, PSG IMS and R, Peelamedu, Coimbatore, Tamil Nadu, India
| | - P Krishnam Raju
- Department of Nephrology, PSG IMS and R, Peelamedu, Coimbatore, Tamil Nadu, India
| | - H C Madhusudan
- Department of Nephrology, PSG IMS and R, Peelamedu, Coimbatore, Tamil Nadu, India
| |
Collapse
|
175
|
Feng Y, Ma L, Liu L, Hong HG, Zhang X, Guo F, Huang R, Shi M, Li Y, Zhang L, Fu P. Rhabdomyolysis induced AKI via the regulation of endoplasmic reticulum stress and oxidative stress in PTECs. RSC Adv 2016. [DOI: 10.1039/c6ra18865f] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Mechanism for the role of ER stress and oxidative stress activation in rhabdomyolysis-associated AKI.
Collapse
|
176
|
Abstract
Rhabdomyolysis is a condition in which striated muscle tissue breaks down rapidly and releases muscular cell constituents into extracellular fluid and the circulation. Renal symptoms, such as acute renal failure, are major complications of rhabdomyolysis. However, no previous report of rhabdomyolysis associated with orbital complication has been issued. Here, we report the first patient of rhabdomyolysis presenting as orbital apex syndrome. A 66-year-old man presented with right periorbital swelling with erythematous patches and conjunctival chemosis. In addition, swelling, redness, and vesicles were observed in both lower legs. He was found in a drunken state with the right side of his face pressed against a table. Ophthalmic examination showed right eye fixation in all directions and ischemic change of retina. Blood testing showed elevated muscle enzyme associated with muscle destruction. And computed tomography of the orbit showed swelling of right extraocular muscles and crowding of right orbital apex. Under a diagnosis of rhabdomyolysis-associated orbital apex syndrome and central retinal artery occlusion, intravenous steroid and antibiotics therapy with intraocular pressure-lowering topicals were begun. Clinical presentation, treatment course, and follow-up are discussed.
Collapse
|
177
|
Nishimura H, Enokida H, Kawahira S, Kagara I, Hayami H, Nakagawa M. Acute Kidney Injury and Rhabdomyolysis After Protobothrops flavoviridis Bite: A Retrospective Survey of 86 Patients in a Tertiary Care Center. Am J Trop Med Hyg 2015; 94:474-9. [PMID: 26643529 DOI: 10.4269/ajtmh.15-0549] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 11/03/2015] [Indexed: 11/07/2022] Open
Abstract
Acute kidney injury (AKI) is the main cause of death for victims of hematoxic snakebites. A few studies have described improvement in AKI rates in snakebite cases, but the reasons for the improvement have not been investigated. Eighty-six patients with Protobothrops flavoviridis bites admitted to a single center from January 2003 through March 2014 were included in the study. Clinical variables, including age, sex, blood pressure (BP), and serum creatinine (S-Cre), on admission were compared between patients with and without AKI. One patient died of disseminated intravascular coagulation following AKI (mortality rate 1.1%). Six patients developed AKI with rhabdomyolysis. Systolic BP, S-Cre, serum creatine kinase, white blood cell count, and platelet count differed significantly between the AKI and non-AKI groups (P = 0.01). Three of the six patients were physically challenged to a degree that made it difficult for them to move or communicate, and these difficulties likely exacerbated the severity of snakebite complications. Our study demonstrated that the risk of snakebite-induced AKI for physically challenged patients was high. To further reduce mortality due to snakebite-induced AKI, we need to make it possible for physically challenged patients to receive first aid sooner.
Collapse
Affiliation(s)
- Hiroaki Nishimura
- Division of Blood Purification, Kagoshima Prefectural Ohshima Hospital, Kagoshima, Japan; Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan; Blood Purification Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Hideki Enokida
- Division of Blood Purification, Kagoshima Prefectural Ohshima Hospital, Kagoshima, Japan; Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan; Blood Purification Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Shuichirou Kawahira
- Division of Blood Purification, Kagoshima Prefectural Ohshima Hospital, Kagoshima, Japan; Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan; Blood Purification Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Ichiro Kagara
- Division of Blood Purification, Kagoshima Prefectural Ohshima Hospital, Kagoshima, Japan; Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan; Blood Purification Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Hiroshi Hayami
- Division of Blood Purification, Kagoshima Prefectural Ohshima Hospital, Kagoshima, Japan; Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan; Blood Purification Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Masayuki Nakagawa
- Division of Blood Purification, Kagoshima Prefectural Ohshima Hospital, Kagoshima, Japan; Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan; Blood Purification Center, Kagoshima University Hospital, Kagoshima, Japan
| |
Collapse
|
178
|
Raurich JM, Llompart-Pou JA, Rodríguez-Yago M, Ferreruela M, Royo C, Ayestarán I. Role of Elevated Aminotransferases in ICU Patients with Rhabdomyolysis. Am Surg 2015. [DOI: 10.1177/000313481508101219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
To evaluate whether patients with rhabdomyolysis and serum alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) higher than 1000 IU/L had higher mortality that patients with low aminotransferases. Retrospective analysis of intensive care unit patients with rhabdomyolysis [creatine kinase (CK) higher than 5000 IU/L]. Patients were classified in two groups: low aminotransferases group, when AST and ALT were equal or lower to 1000 IU/L, and elevated aminotransferases group, when AST or ALT was above 1000 IU/L. Forty-six out of 189 patients included in the analysis (24.3%) had elevated aminotransferases. The mortality of patients with rhabdomyolysis was 25.9 per cent, being higher in patients with elevated aminotransferases compared with patients with low aminotransferases (60.9% vs 14.7%; P < 0.001). Mortality stratified by quartiles of CK in patients with low aminotransferases was independent of the level of CK ( P = 0.67). Logistic regression analysis showed that the independent variables associated with mortality were Simplified Acute Physiology Score II [1.11 (1.07–1.16) for each point of increase, P < 0.001], the international normalized ratio value [4.2 (1.6–10.7) for each point of increase, P = 0.003], and the need of renal replacement therapy [5.4 (1.7–17.2), P = 0.004]. Patients with rhabdomyolysis with elevated serum aminotransferases had higher mortality than patients with low serum aminotransferase levels.
Collapse
Affiliation(s)
- Joan M. Raurich
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain
| | - Juan A. Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain
| | - Miguel Rodríguez-Yago
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain
| | - Mireia Ferreruela
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain
| | - Cristina Royo
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain
| | - Ignacio Ayestarán
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain
| |
Collapse
|
179
|
Low-Intensity Repetitive Exercise Induced Rhabdomyolysis. Case Rep Emerg Med 2015; 2015:281540. [PMID: 26693360 PMCID: PMC4674583 DOI: 10.1155/2015/281540] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/11/2015] [Indexed: 12/27/2022] Open
Abstract
Rhabdomyolysis is a rare condition caused by the proteins of damaged muscle cells entering the bloodstream and damaging the kidneys. Common symptoms of rhabdomyolysis are muscle pain and fatigue in conjunction with dark urine; kidney damage is a common symptom among these patients. We present a case of a 23-year-old woman who displayed myalgia in the upper extremities caused by low-intensity and high-repetition exercise. She was successfully diagnosed and treated for exertional rhabdomyolysis. This patient had no significant medical history that would induce this condition. We urge the emergency medical community to observe and monitor patients that complain of myalgia to ensure they are not suffering from rhabdomyolysis even in atypical cases.
Collapse
|
180
|
Rhabdomyolysis and Acute Kidney Injury Requiring Dialysis as a Result of Concomitant Use of Atypical Neuroleptics and Synthetic Cannabinoids. Case Rep Nephrol 2015; 2015:235982. [PMID: 26550500 PMCID: PMC4621326 DOI: 10.1155/2015/235982] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/21/2015] [Accepted: 09/29/2015] [Indexed: 01/06/2023] Open
Abstract
The use of synthetic cannabinoids (SCBs) is associated with many severe adverse effects that are not observed with marijuana use. We report a unique case of a patient who developed rhabdomyolysis and acute kidney injury (AKI) requiring dialysis after use of SCBs combined with quetiapine. Causes for the different adverse effects profile between SCBs and marijuana are not defined yet. Cases reported in literature with SCBs use have been associated with reversible AKI characterized by acute tubular necrosis and interstitial nephritis. Recent studies have showed the involvement of cytochromes P450s (CYPs) in biotransformation of SCBs. The use of quetiapine which is a substrate of the CYP3A4 and is excreted (73%) as urine metabolites may worsen the side effect profiles of both quetiapine and K2. SCBs use should be included in the differential diagnosis of AKI and serum Creatinine Phosphokinase (CPK) level should be monitored. Further research is needed to identify the mechanism of SCBs nephrotoxicity.
Collapse
|
181
|
Roncal-Jimenez C, García-Trabanino R, Barregard L, Lanaspa MA, Wesseling C, Harra T, Aragón A, Grases F, Jarquin ER, González MA, Weiss I, Glaser J, Sánchez-Lozada LG, Johnson RJ. Heat Stress Nephropathy From Exercise-Induced Uric Acid Crystalluria: A Perspective on Mesoamerican Nephropathy. Am J Kidney Dis 2015; 67:20-30. [PMID: 26455995 DOI: 10.1053/j.ajkd.2015.08.021] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 08/07/2015] [Indexed: 11/11/2022]
Abstract
Mesoamerican nephropathy (MeN), an epidemic in Central America, is a chronic kidney disease of unknown cause. In this article, we argue that MeN may be a uric acid disorder. Individuals at risk for developing the disease are primarily male workers exposed to heat stress and physical exertion that predisposes to recurrent water and volume depletion, often accompanied by urinary concentration and acidification. Uric acid is generated during heat stress, in part consequent to nucleotide release from muscles. We hypothesize that working in the sugarcane fields may result in cyclic uricosuria in which uric acid concentrations exceed solubility, leading to the formation of dihydrate urate crystals and local injury. Consistent with this hypothesis, we present pilot data documenting the common presence of urate crystals in the urine of sugarcane workers from El Salvador. High end-of-workday urinary uric acid concentrations were common in a pilot study, particularly if urine pH was corrected to 7. Hyperuricemia may induce glomerular hypertension, whereas the increased urinary uric acid may directly injure renal tubules. Thus, MeN may result from exercise and heat stress associated with dehydration-induced hyperuricemia and uricosuria. Increased hydration with water and salt, urinary alkalinization, reduction in sugary beverage intake, and inhibitors of uric acid synthesis should be tested for disease prevention.
Collapse
Affiliation(s)
| | - Ramón García-Trabanino
- Scientific Board, Department of Investigation, Hospital Nacional Rosales, San Salvador, El Salvador
| | - Lars Barregard
- Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Miguel A Lanaspa
- Division of Kidney Diseases and Hypertension, University of Colorado, Denver, CO
| | - Catharina Wesseling
- Unit of Occupational Medicine, Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden
| | - Tamara Harra
- Division of Kidney Diseases and Hypertension, University of Colorado, Denver, CO
| | - Aurora Aragón
- Research Center on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua at León (UNAN-León), León, Nicaragua
| | - Felix Grases
- University of Balearic Islands, Palma de Mallorca, Spain
| | - Emmanuel R Jarquin
- Agencia para el Desarrollo y la Salud Agropecuaria, San Salvador, El Salvador
| | - Marvin A González
- Research Center on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua at León (UNAN-León), León, Nicaragua; Department of Non-communicable Disease Epidemiology of London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ilana Weiss
- La Isla Foundation, San Salvador, El Salvador
| | | | - Laura G Sánchez-Lozada
- Laboratory of Renal Physiopathology and Nephrology Department, INC Ignacio Chavez, Mexico City, Mexico
| | - Richard J Johnson
- Division of Kidney Diseases and Hypertension, University of Colorado, Denver, CO; Division of Nephrology, Eastern Colorado Health Care System, Department of Veteran Affairs, Denver, CO.
| |
Collapse
|
182
|
Nishida K, Watanabe H, Ogaki S, Kodama A, Tanaka R, Imafuku T, Ishima Y, Giam Chuang VT, Toyoda M, Kondoh M, Wu Q, Fukagawa M, Otagiri M, Maruyama T. Renoprotective effect of long acting thioredoxin by modulating oxidative stress and macrophage migration inhibitory factor against rhabdomyolysis-associated acute kidney injury. Sci Rep 2015; 5:14471. [PMID: 26412311 PMCID: PMC4585989 DOI: 10.1038/srep14471] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 08/28/2015] [Indexed: 01/15/2023] Open
Abstract
Rhabdomyolysis-associated acute kidney injury (AKI) is a serious life-threatening condition. As such, more effective strategies are needed for its prevention. Thioredoxin-1 (Trx), a redox-active and macrophage migration inhibitory factor (MIF) modulating protein, has a short retention time in the blood. We examined the renoprotective effect of long acting Trx that was genetically fused with human serum albumin (HSA-Trx) against glycerol-induced AKI. An intravenous HSA-Trx pre-treatment attenuated the glycerol-induced decline in renal function, compared to a PBS, HSA or Trx alone. HSA-Trx caused a reduction in the tubular injuries and in the number of apoptosis-positive tubular cells. Renal superoxide, 8-hydroxy deoxyguanosine, nitrotyrosine and the plasma Cys34-cysteinylated albumin were clearly suppressed by the HSA-Trx treatment. Prior to decreasing TNF-α and IL-6, HSA-Trx suppressed an increase of plasma MIF level. In LLC-PK1 cells, HSA-Trx decreased the level of reactive oxygen species and lactate dehydrogenase release induced by myoglobin. HSA-Trx treatment resulted in a threefold increase in the survival of lethal glycerol-treated mice. The post-administration of HSA-Trx at 1 and 3 hr after glycerol injection exerted a significant renoprotective effect. These results suggest HSA-Trx has potential for use in the treatment of rhabdomyolysis-associated AKI via its extended effects of modulating oxidative stress and MIF.
Collapse
Affiliation(s)
- Kento Nishida
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1, Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Hiroshi Watanabe
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1, Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
- Center for Clinical Pharmaceutical Sciences, School of Pharmacy, Kumamoto University, 5-1, Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Shigeru Ogaki
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1, Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Azusa Kodama
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1, Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Ryota Tanaka
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1, Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Tadashi Imafuku
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1, Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Yu Ishima
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1, Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
- Center for Clinical Pharmaceutical Sciences, School of Pharmacy, Kumamoto University, 5-1, Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Victor Tuan Giam Chuang
- School of Pharmacy, Faculty of Health Sciences, Curtin Health Innovation Research Institute, Curtin University, GPO Box U1987, Perth 6845, WA, Australia
| | - Masao Toyoda
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara 259-1193, Japan
| | - Masumi Kondoh
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara 259-1193, Japan
| | - Qiong Wu
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara 259-1193, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara 259-1193, Japan
| | - Masaki Otagiri
- Faculty of Pharmaceutical Sciences, Sojo University, 4-22-1, Ikeda, Nishi-ku, Kumamoto 860-0082, Japan
- DDS Research Institute, Sojo University, 4-22-1, Ikeda, Nishi-ku, Kumamoto 860-0082, Japan
| | - Toru Maruyama
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1, Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
- Center for Clinical Pharmaceutical Sciences, School of Pharmacy, Kumamoto University, 5-1, Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| |
Collapse
|
183
|
Şahin T. PRIS may be diagnosed before ICU period for patients undergoing cardiopulmonary bypass. Perfusion 2015; 31:281-7. [PMID: 26354738 DOI: 10.1177/0267659115604708] [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] [Indexed: 11/15/2022]
Abstract
There are many published articles on the clinical manifestations of propofol-related infusion syndrome (PRIS), but they are not the same in each case.(1)Moreover, PRIS is only encountered infrequently and, therefore, it may create a diagnostic challenge. Nearly all of the published articles on PRIS are related to the use of long-term (> 48 hour) propofol infusion with a dose range of at least 4-5 mg/kg/h. In this case, not only a short duration, but also a low-dose propofol administration seems to induce PRIS. A 73-year-old male patient under cardiopulmonary bypass (CPB) suffered from some clinical symptoms of PRIS, such as hyperlactatemia and persistent low metabolic acidosis which promptly resolved on the discontinuation of propofol. Therefore, we suggest that any propofol administration (bolus or infusion) may result in such clinical symptoms, which may be the earliest indicators of PRIS. When those symptoms are observed on propofol administration during cardiopulmonary bypass (CPB), the perfusionist must alert both the anaesthesiologist and the surgeon to stop the propofol in order to prevent the patient from further adverse effects of PRIS.
Collapse
Affiliation(s)
- Türker Şahin
- Near East University Hospital, Perfusion Services, Nicosia, Northern Cyprus, Turkey
| |
Collapse
|
184
|
Abstract
Acute compartment syndrome is described as an elevation of interstitial pressure in a closed fascial compartment that can lead to damage of the microvasculature with subsequent tissue necrosis. Although paravertebral compartment syndrome has been described there is no case of paravertebral compartment syndrome that has been described in the pediatric population. We report the case of a 17-year-old boy who presented at our institution with severe, acute-onset low back pain that started shortly after a rigorous 4-hour workout. He was diagnosed with acute lumbar paravertebral compartment syndrome and underwent emergent fasciotomy with 2 more debridements.
Collapse
|
185
|
Estaphan S, Eissa H, Elattar S, Rashed L, Farouk M. A study on the effect of cimetidine and L-carnitine on myoglobinuric acute kidney injury in male rats. Injury 2015; 46:1223-30. [PMID: 25930980 DOI: 10.1016/j.injury.2015.03.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 02/16/2015] [Accepted: 03/30/2015] [Indexed: 02/06/2023]
Abstract
Myoglobinuric acute renal failure is the most important life threatening complication of rhabdomyolysis. Iron, free radicals, nitric oxide and cytochrome p450 are involved in the pathogenesis of mARF. The aim of this study is to compare the effect of cimetidine, l-carnitine and both agents together on mARF in rats. Forty rats were divided into 5 groups; group I: control rats, group II: myoglobinuric ARF rats, group III: mARF rats received l-carnitine (200mg/kg, i.p.), group IV: mARF rats received cimetidine (150mg/kg i.p.) and group V: mARF rats received both agents together. 48h after glycerol injection, systolic blood pressure was measured. Urine and blood samples were collected to evaluate urine volume, GFR, BUN, creatinine, K, Na, serum creatine kinase, NO and glutathione levels. Kidney specimens were taken to investigate renal cytochrome p450 and for histological examinations. Cimetidine treatment significantly decreased creatinine, BUN, K, Na, SBP and creatine kinase and increased GFR and urine volume compared to group II. l-carnitine exerted similar changes except for the effect on K and GFR. NO was significantly decreased, while renal glutathione and cytochrome p450 were significantly increased in groups treated with l-carnitine or cimetidine as compared to group II. Combined treatment further improved renal functions, creatine kinase, oxidative stress parameters and SBP as compared to each therapy alone. The histological changes confirmed the biochemical findings. Cimetidine and l-carnitine have protective effects - almost equally - against mARF. Using both agents together, minimises the renal injury.
Collapse
Affiliation(s)
- Suzanne Estaphan
- Physiology Department, Faculty of Medicine, Cairo University, Giza, Egypt.
| | - Hassan Eissa
- Physiology Department, Faculty of Medicine, Cairo University, Giza, Egypt.
| | - Samah Elattar
- Physiology Department, Faculty of Medicine, Cairo University, Giza, Egypt.
| | - Laila Rashed
- Biochemistry and Molecular Biology Department, Faculty of Medicine, Cairo University, Giza, Egypt.
| | - Mira Farouk
- Histology Department, Faculty of Medicine, Cairo University, Giza, Egypt.
| |
Collapse
|
186
|
Sever MS, Vanholder R. Crush Syndrome: A Case Report and Review of the Literature. J Emerg Med 2015; 48:730-1. [DOI: 10.1016/j.jemermed.2014.07.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/28/2014] [Indexed: 10/23/2022]
|
187
|
Rhabdomyolysis and acute renal failure after gardening. Case Rep Emerg Med 2015; 2015:174892. [PMID: 25954536 PMCID: PMC4410754 DOI: 10.1155/2015/174892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/05/2015] [Indexed: 01/06/2023] Open
Abstract
Acute nontraumatic exertional rhabdomyolysis may arise when the energy supply to muscle is insufficient to meet demands, particularly in physically untrained individuals. We report on a psychiatric patient who developed large bruises and hemorrhagic blisters on both hands and arms, rhabdomyolysis of both forearm muscles with a moderate compartment syndrome, and consecutive acute renal failure following excessive work in the garden. Although specifically asked, the patient denied any hard physical work or gardening, and heteroanamnestic data were not available. The diagnosis of rhabdomyolysis was easy to establish, but until reliable anamnestic data were obtained, the etiology remained uncertain. Four days after arrival, the patient recalled working hard in the garden. The etiology of rhabdomyolysis was finally reached, and the importance of anamnestic data was once more confirmed.
Collapse
|
188
|
Suthar KS, Vanikar AV, Trivedi HL. Acute Kidney Injury and Quadriparesis Due to Rosuvastatin Induced Rhabdomyolysis- A Case Report. J Clin Diagn Res 2015; 9:OD08-9. [PMID: 26155510 PMCID: PMC4484102 DOI: 10.7860/jcdr/2015/12117.5909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/30/2015] [Indexed: 11/24/2022]
Abstract
Statins as lipid lowering drugs, are safe and effective in reducing cardiovascular disease risk, but rarely produce myopathy like myalgia, myositis or rhabdomyolysis. We report the case of Rosuvastatin induced rhabdomyolytic acute renal failure and quadriparesis in a 67-year old male, a known case of type-2 diabetes mellitus and with a history of coronary angioplasty four months back. He was on antihypertensive, oral hypoglycemic and antiplatelet medications with Rosuvastatin 40mg/day. He was admitted with altered sensorium, breathlessness, vomiting, muscle weakness and decreased urine output and had raised serum creatinine, creatinine phosphokinase and myoglobin. After ruling out all other causation for rhabdomyolysis, we stopped Rosuvastatin and started supportive management and hemodialysis. Patient showed gradual recovery in renal function and quadriparesis. Patient was discharged with good urine output and on antihypertensive, hypoglycemic drug and diet restrictions for lipid control. He recovered completely and had normal renal function with well controlled lipid level on follow up of 6 months after discharge. Thus, prompt diagnosis of Rhabdomyolysis due to Rosuvastatin in absence of other aetiology and the multidisciplinary management can prevent further complication with favorable outcome.
Collapse
Affiliation(s)
- Kamlesh S. Suthar
- Assistant Professor, Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, G.R. Doshi and K.M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Aruna V. Vanikar
- Professor, Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, G.R. Doshi and K.M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Hargovind L. Trivedi
- Professor, Department of Nephrology and Transplantation Medicine, (IKDRC-ITS), Ahmedabad, India
| |
Collapse
|
189
|
Sever MS, Lameire N, Van Biesen W, Vanholder R. Disaster nephrology: a new concept for an old problem. Clin Kidney J 2015; 8:300-9. [PMID: 26034592 PMCID: PMC4440471 DOI: 10.1093/ckj/sfv024] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 03/30/2015] [Indexed: 11/20/2022] Open
Abstract
Natural and man-made mass disasters directly or indirectly affect huge populations, who need basic infrastructural help and support to survive. However, despite the potentially negative impact on survival chances, these health care issues are often neglected by the authorities. Treatment of both acute and chronic kidney diseases (CKDs) is especially problematic after disasters, because they almost always require complex technology and equipment, whereas specific drugs may be difficult to acquire for the treatment of the chronic kidney patients. Since many crush victims in spite of being rescued alive from under the rubble die afterward due to lack of dialysis possibilities, the terminology of ‘renal disaster’ was introduced after the Armenian earthquake. It should be remembered that apart from crush syndrome, multiple aetiologies of acute kidney injury (AKI) may be at play in disaster circumstances. The term ‘seismonephrology’ (or earthquake nephrology) was introduced to describe the need to treat not only a large number of AKI cases, but the management of patients with CKD not yet on renal replacement, as well as of patients on haemodialysis or peritoneal dialysis and transplanted patients. This wording was later replaced by ‘disaster nephrology’, because besides earthquakes, many other disasters such as hurricanes, tsunamis or wars may have a negative impact on the ultimate outcome of kidney patients. Disaster nephrology describes the handling of the many medical and logistic problems in treating kidney patients in difficult circumstances and also to avoid post-disaster chaos, which can be made possible by preparing medical and logistic scenarios. Learning and applying the basic principles of disaster nephrology is vital to minimize the risk of death both in AKI and CKD patients.
Collapse
Affiliation(s)
- Mehmet Sukru Sever
- Department of Internal Medicine/Nephrology , Istanbul School of Medicine , Istanbul , Turkey
| | - Norbert Lameire
- Department of Internal Medicine, Nephrology Section , University Hospital , Ghent , Belgium
| | - Wim Van Biesen
- Renal Disaster Relief Task Force (RDRTF) of the International Society of Nephrology (ISN) European Branch , University Hospital , Ghent , Belgium
| | - Raymond Vanholder
- Department of Internal Medicine, Nephrology Section , University Hospital , Ghent , Belgium
| |
Collapse
|
190
|
Sowards KJ, Mukherjee K, Norris PR, Shintani A, Ware LB, Roberts LJ, May AK. Elevated serum creatine phosphokinase is associated with mortality and inotropic requirement in critically injured adults. Injury 2014; 45:2096-100. [PMID: 25441175 PMCID: PMC4877131 DOI: 10.1016/j.injury.2014.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/30/2014] [Accepted: 09/12/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hemeproteins such as free myoglobin can undergo autoxidation and catalyse lipid peroxidation, increasing oxidative stress. Creatine phosphokinase (CPK) elevation is a marker for free myoglobin after myocyte damage. Since oxidative injury is a key mechanism of injury-related organ dysfunction, we hypothesised that serum CPK levels correlate with mortality and need for inotropic medication and duration of inotropic support, i.e. shock, among critically injured patients. METHODS We conducted a retrospective review of 17,847 patients admitted to a single Trauma Intensive Care Unit over 9 years. 2583 patients with serum CPK levels were included in the analysis. Patient data were collected continuously into an electronic ICU repository. Univariate analysis was accomplished using Spearman correlation and the Mann–Whitney U test. Propensity score adjustment models accounting for potential confounders were used to assess the independent effect of CPK level on mortality, need for inotropic support, and duration of inotropic support. RESULTS Median CPK was significantly higher in patients who died (916 [IQR 332, 2472] vs. 711 [253, 1971], p = 0.004) and in those who required inotropic medications (950 [353, 2525] vs. 469 [188, 1220], p < 0.001). After adjusting for propensity score and potential confounders the odds of mortality increased by 1.10 (95% CI 1.02–1.19, p = 0.020) and the odds of inotropic medication use increased by 1.30 (95% CI 1.22–1.38, p < 0.001) per natural log unit increase in CPK. There was a significant association between CPK level and duration of inotropic support (Spearman's rho .237, p < 0.001) that remained significant in a propensity score-adjusted model. CONCLUSION In critically injured patients, elevated serum CPK level is independently associated with mortality, need for inotropic medication, and duration of inotropic support. This study is the first to evaluate the relationship of CPK level and mortality in addition to surrogate measures of shock in a population of critically injured patients. If these associations are verified prospectively, there may be a role for treatment with hemeprotein reductants, such as paracetamol, to mitigate the effects of shock and end-organ dysfunction.
Collapse
Affiliation(s)
- Kendell J. Sowards
- Division of Trauma and Surgical Critical Care, Vanderbilt University School of Medicine
| | - Kaushik Mukherjee
- Division of Trauma and Surgical Critical Care, Vanderbilt University School of Medicine
| | - Patrick R. Norris
- Division of Trauma and Surgical Critical Care, Vanderbilt University School of Medicine
| | - Ayumi Shintani
- Department of Biostatistics, Vanderbilt University School of Medicine
| | - Lorraine B. Ware
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine
| | | | - Addison K. May
- Division of Trauma and Surgical Critical Care, Vanderbilt University School of Medicine
| |
Collapse
|
191
|
Abstract
This paper summarizes the impact that wars had on the history of nephrology, both worldwide and in the Ghent Medical Faculty notably on the definition, research and clinical aspects of acute kidney injury. The paper briefly describes the role of 'trench nephritis' as observed both during World War I and II, supporting the hypothesis that many of the clinical cases could have been due to Hantavirus nephropathy. The lessons learned from the experience with crush syndrome first observed in World War II and subsequently investigated over many decades form the basis for the creation of the Renal Disaster Relief Task Force of the International Society of Nephrology. Over the last 15 years, this Task Force has successfully intervened both in the prevention and management of crush syndrome in numerous disaster situations like major earthquakes.
Collapse
|
192
|
Redshaw C, Stewart C. Anesthetic agents in patients with very long-chain acyl-coenzyme A dehydrogenase deficiency: a literature review. Paediatr Anaesth 2014; 24:1115-9. [PMID: 25069536 DOI: 10.1111/pan.12474] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2014] [Indexed: 01/17/2023]
Abstract
Very long-chain acyl-coenzyme A dehydrongenase deficiency (VLCADD) is a rare disorder of fatty acid metabolism that renders sufferers susceptible to hypoglycemia, liver failure, cardiomyopathy, and rhabdomyolysis. The literature about the management of these patients is hugely conflicting, suggesting that both propofol and volatile anesthesia should be avoided. We have reviewed the literature and have concluded that the source papers do not support the statements that volatile anesthetic agents are unsafe. The reports on rhabdomyolysis secondary to anesthesia appear to be due to inadequate supply of carbohydrate not volatile agents. Catabolism must be avoided with minimal fasting, glucose infusions based on age and weight, and attenuation of emotional and physical stress. General anesthesia appears to be protective of stress-induced catabolism and may offer benefits in children and anxious patients over regional anesthesia. Propofol has not been demonstrated to be harmful in VLCADD but is presented in an emulsion containing very long-chain fatty acids which can cause organ lipidosis and itself can inhibit mitochondrial fatty acid metabolism. It is therefore not recommended. Suxamethonium-induced myalgia may mimic symptoms of rhabdomyolysis and cause raised CK therefore should be avoided. Opioids, NSAIDS, regional anesthesia, and local anesthetic techniques have all been used without complication.
Collapse
|
193
|
Siavash M, Amini M. Vitamin C may have similar beneficial effects to Gemfibrozil on serum high-density lipoprotein-cholesterol in type 2 diabetic patients. J Res Pharm Pract 2014; 3:77-82. [PMID: 25328896 PMCID: PMC4199195 DOI: 10.4103/2279-042x.141075] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: Type 2 diabetes mellitus (DM-T2) is commonly associated with increased triglycerides (TG), low-density lipoprotein cholesterol (LDL-C) and low high-density lipoprotein cholesterol (HDL-C) levels. Fibrates like gemfibrozil are frequently used in diabetic patients to decrease TG and increase HDL-C levels. We compared the efficacy of Vitamin C, an antioxidant vitamin, with gemfibrozil on serum HDL-C in diabetic patients. Methods: Type 2 diabetic patients, referred to our out-patient clinic were randomly divided into three groups. After 1 month of lifestyle and diet modifications, groups A, B, and C were prescribed 1000 mg Vitamin C, 600 mg gemfibrozil and combination of both, respectively. Before the study initiation and after 6th week of drug prescription, the blood samples were taken and analyzed for total cholesterol (Total-C), HDL-C, TG, fasting blood sugar (FBS), and hemoglobin A1c (HbA1c) levels. Findings: Sixty-seven patients entered, and 50 patients (18 male, 32 female) finished the study. Overall, serum HDL-C increased significantly from 39.8 to 45.2 mg/dL in the participants (P = 0.001). HDL-C increased 6.3, 4.4 and 5.0 mg/dL in groups A, B and C, respectively (related significances were 0.017, 0.022 and 0.033, respectively). Significant decrease of serum TG and Total-C occurred in gemfibrozil and combination groups, but not in Vitamin C group. Changes in serum HDL-C between three groups were not significant (P = 0.963). We found a significant decrease in TG and Total-C in the groups B and C (P < 0.05), but no significant changes of TG, Total-C, LDL-C, FBS and HbA1c in group A (P > 0.05). Conclusion: The results demonstrated that Vitamin C may have beneficial effects on HDL-C in diabetic patients without significant effects on plasma glucose or other lipid parameters; however, its role for the treatment of low HDL-C patients should be evaluated in larger studies.
Collapse
Affiliation(s)
- Mansour Siavash
- Department of Endocrinology, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Amini
- Department of Endocrinology, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
194
|
Abstract
Acute kidney injury (AKI) is becoming more prevalent in the hospital setting and is associated with the worst prognostic outcomes, including increased mortality. Many different factors contribute to the development of AKI in hospitalized patients, including medications, older age, sepsis, and comorbid conditions. Correct evaluation and management of AKI requires investigation and understanding of important causative factors for each of the 3 pathophysiologic categories of renal failure. Preventative efforts rely on prompt recognition of AKI while avoiding iatrogenic insults in the hospital setting.
Collapse
Affiliation(s)
- Parham Eftekhari
- Broward Health Medical Center, Nova Southeastern University College of Osteopathic Medicine, 6301 Southwest 112 Street, Miami, FL 33156, USA.
| |
Collapse
|
195
|
Hipertransaminasemia moderada en paciente asintomático tras realización de esfuerzo físico en gimnasio. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 37:493-4. [DOI: 10.1016/j.gastrohep.2014.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 03/31/2014] [Indexed: 11/24/2022]
|
196
|
Belliere J, Casemayou A, Ducasse L, Zakaroff-Girard A, Martins F, Iacovoni JS, Guilbeau-Frugier C, Buffin-Meyer B, Pipy B, Chauveau D, Schanstra JP, Bascands JL. Specific macrophage subtypes influence the progression of rhabdomyolysis-induced kidney injury. J Am Soc Nephrol 2014; 26:1363-77. [PMID: 25270069 DOI: 10.1681/asn.2014040320] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/29/2014] [Indexed: 01/06/2023] Open
Abstract
Rhabdomyolysis can be life threatening if complicated by AKI. Macrophage infiltration has been observed in rat kidneys after glycerol-induced rhabdomyolysis, but the role of macrophages in rhabdomyolysis-induced AKI remains unknown. Here, in a patient diagnosed with rhabdomyolysis, we detected substantial macrophage infiltration in the kidney. In a mouse model of rhabdomyolysis-induced AKI, diverse renal macrophage phenotypes were observed depending on the stage of the disease. Two days after rhabdomyolysis, F4/80(low)CD11b(high)Ly6b(high)CD206(low) kidney macrophages were dominant, whereas by day 8, F4/80(high)CD11b(+)Ly6b(low)CD206(high) cells became the most abundant. Single-cell gene expression analyses of FACS-sorted macrophages revealed that these subpopulations were heterogeneous and that individual cells simultaneously expressed both M1 and M2 markers. Liposomal clodronate-mediated macrophage depletion significantly reduced the early infiltration of F4/80(low)CD11b(high)Ly6b(high)CD206(low) macrophages. Furthermore, transcriptionally regulated targets potentially involved in disease progression, including fibronectin, collagen III, and chemoattractants that were identified via single-cell analysis, were verified as macrophage-dependent in situ. In vitro, myoglobin treatment induced proximal tubular cells to secrete chemoattractants and macrophages to express proinflammatory markers. At day 30, liposomal clodronate-mediated macrophage depletion reduced fibrosis and improved both kidney repair and mouse survival. Seven months after rhabdomyolysis, histologic lesions were still present but were substantially reduced with prior depletion of macrophages. These results suggest an important role for macrophages in rhabdomyolysis-induced AKI progression and advocate the utility of long-term follow-up for patients with this disease.
Collapse
Affiliation(s)
- Julie Belliere
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institute of Cardiovascular and Metabolic Diseases, Toulouse, France; Université de Toulouse III Paul Sabatier, Toulouse, France; Department of Nephrology and Organ Transplantation, Centre Hospitalier Universitaire Rangueil, Toulouse, France
| | - Audrey Casemayou
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institute of Cardiovascular and Metabolic Diseases, Toulouse, France; Université de Toulouse III Paul Sabatier, Toulouse, France
| | - Laure Ducasse
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institute of Cardiovascular and Metabolic Diseases, Toulouse, France; Université de Toulouse III Paul Sabatier, Toulouse, France
| | - Alexia Zakaroff-Girard
- Cytometry and Cell-sorting Platform, INSERM/Unité Mixte de Recherche U1048, Toulouse, France
| | - Frédéric Martins
- Genome and Transcriptome Platform, Toulouse Genopole INSERM/Unité Mixte de Recherche U1048, University Paul Sabatier, Toulouse, France
| | - Jason S Iacovoni
- Bioinformatic Platform, INSERM/Unité Mixte de Recherche U1048, University Paul Sabatier, Toulouse, France
| | - Céline Guilbeau-Frugier
- Université de Toulouse III Paul Sabatier, Toulouse, France; Department of Pathology, Toulouse University Hospital, Rangueil, Toulouse, France; and
| | - Bénédicte Buffin-Meyer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institute of Cardiovascular and Metabolic Diseases, Toulouse, France; Université de Toulouse III Paul Sabatier, Toulouse, France
| | - Bernard Pipy
- Unité Mixte de Recherche 152, Macrophages Polarization and Nuclear Receptors, Toulouse, France
| | - Dominique Chauveau
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institute of Cardiovascular and Metabolic Diseases, Toulouse, France; Université de Toulouse III Paul Sabatier, Toulouse, France; Department of Nephrology and Organ Transplantation, Centre Hospitalier Universitaire Rangueil, Toulouse, France
| | - Joost P Schanstra
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institute of Cardiovascular and Metabolic Diseases, Toulouse, France; Université de Toulouse III Paul Sabatier, Toulouse, France;
| | - Jean-Loup Bascands
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institute of Cardiovascular and Metabolic Diseases, Toulouse, France; Université de Toulouse III Paul Sabatier, Toulouse, France;
| |
Collapse
|
197
|
Hechanova LA, Sadjadi SA. Severe hypercalcemia complicating recovery of acute kidney injury due to rhabdomyolysis. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:393-6. [PMID: 25218143 PMCID: PMC4172091 DOI: 10.12659/ajcr.891046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patient: Male, 23 Final Diagnosis: Rabdomyolysis Symptoms: Cardiac arrest • cardiac arrhythmia • hypercalcemia Medication: — Clinical Procedure: — Specialty: —
Collapse
Affiliation(s)
- Lisa Aimee Hechanova
- Nephrology Section, Jerry L. Pettis Veterans Memorial Medical Center, Loma Linda University School of Medicine, Loma Linda, USA
| | - Seyed-Ali Sadjadi
- Nephrology Section, Jerry L. Pettis Veterans Memorial Medical Center, Loma Linda University School of Medicine, Loma Linda, USA
| |
Collapse
|
198
|
Abstract
BACKGROUND Rhabdomyolysis may cause severe damage to the human body because of acute renal failure, fatal heart rhythm disturbances, hypovolemic shock, disturbances of electrolyte balance, metabolic acidosis, hyperthermia, disseminated intravascular coagulation, etc. Drugs and toxins are the most common factors for the disease. This article aimed to review the prognosis of rhabdomyolysis. DATA SOURCES Based on the reported studies of cell and molecular biology, we reviewed the clinical presentations, laboratory findings, and mechanisms of rhabdomyolysis in the Pubmed. RESULTS The clinical symptoms of rhabdomyolysis were dependent on the severity of the condition and whether kidney failure develops. Since the necrosis and dissolution of muscle cells, entocytes such as myoglobin, creatine phosphokinase (CPK), electrolytes, proteins and non-protein substances were released into the plasma, the detection of the entocytes may contribute to the early diagnosis of rhabdomyolysis. CONCLUSION Despite the etiology of the disease is multifactorial, the potential causes of rhabdomyolysis share the same pathophysiological pathway involving an increase in intracellular calcium.
Collapse
Affiliation(s)
- Mei-Hua Zhang
- Department of Pharmacy, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310006, China
| |
Collapse
|
199
|
Goel N, Pullman JM, Coco M. Cocaine and kidney injury: a kaleidoscope of pathology. Clin Kidney J 2014; 7:513-7. [PMID: 25859366 PMCID: PMC4389131 DOI: 10.1093/ckj/sfu092] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/13/2014] [Indexed: 12/21/2022] Open
Abstract
Cocaine is abused worldwide as a recreational drug. It is a potent activator of the sympathetic nervous system leading to intense vasoconstriction, endothelial dysfunction, oxidative stress, platelet activation and decrease in prostaglandins E2 and prostacyclin. Cocaine can lead to widespread systemic adverse effects such as stroke, myocardial infarction, arterial dissection, vascular thrombosis and rhabdomyolysis. In human and rat kidneys, cocaine has been associated with glomerular, tubular, vascular and interstitial injury. It is not uncommon to diagnose cocaine-related acute kidney injury (AKI), malignant hypertension and chronic kidney disease. Cocaine abuse can lead to AKI by rhabdomyolysis, vasculitis, infarction, thrombotic microangiopathy and malignant hypertension. It is reported that 50–60% of people who use both cocaine and heroin are at increased risk of HIV, hepatitis and additional risk factors that can cause kidney diseases. While acute interstitial nephritis (AIN) is a known cause of AKI, an association of AIN with cocaine is unusual and seldom reported. We describe a patient with diabetes mellitus, hypertension and chronic hepatitis C, who presented with AKI. Urine toxicology was positive for cocaine and a kidney biopsy was consistent with AIN. Illicit drugs such as cocaine or contaminants may have caused AIN in this case and should be considered in the differential diagnosis of causes of AKI in a patient with substance abuse. We review the many ways that cocaine adversely impacts on kidney function.
Collapse
Affiliation(s)
- Narender Goel
- Division of Nephrology and Hospital Medicine , Middletown Medical PC and Orange Regional Medical Center , Middletown, NY , USA ; Division of Nephrology , Montefiore Medical Center & Albert Einstein College of Medicine , Bronx, NY , USA
| | - James M Pullman
- Division of Pathology , Montefiore Medical Center & Albert Einstein College of Medicine , Bronx, NY , USA
| | - Maria Coco
- Division of Nephrology , Montefiore Medical Center & Albert Einstein College of Medicine , Bronx, NY , USA
| |
Collapse
|
200
|
Kolhe N, Lewis J, McCulloch TA. Risk of statin-induced rhabdomyolysis in patients with hepatic impairment. BMJ Case Rep 2014; 2014:bcr-2014-204013. [PMID: 25213784 DOI: 10.1136/bcr-2014-204013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe a case of a 54-year-old man with a 2-month history of biliary colic associated with a common bile duct stone. He underwent laparoscopic cholecystectomy and developed postoperative acute kidney injury stage 3. A renal biopsy was performed and demonstrated myoglobin in the renal tubules. Retrospective creatine kinase analysis was suggestive of rhabdomyolysis. It is thought this was precipitated by simvastatin accumulation in the context of a period of hepatic impairment and elevated liver enzymes.
Collapse
|