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Costantini A, Moletta L, Pierobon ES, Serafini S, Valmasoni M, Sperti C. Paraneoplastic myopathy-related rhabdomyolysis and pancreatic cancer: A case report and review of the literature. World J Clin Cases 2023; 11:6823-6830. [PMID: 37901020 PMCID: PMC10600837 DOI: 10.12998/wjcc.v11.i28.6823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/22/2023] [Accepted: 09/07/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Rhabdomyolysis is a life-threatening condition, often leading to progressive renal failure and death. It is caused by destruction of skeletal muscle and the release of myoglobin and other intracellular contents into the circulation. The most frequent cause of this condition is "crush syndrome", although several others have been described and paraneoplastic inflammatory myopathies associated with various types of cancer are repeatedly reported. CASE SUMMARY We describe a rare case of a patient with pancreatic cancer who developed rhabdomyolysis early on, possibly due to paraneoplastic myositis leading to acute renal failure and eventually to rapid death. A 78-year-old Caucasian woman was referred to our hospital for obstructive jaundice and weight loss due to a lesion in the pancreatic head. She presented increasingly severe renal insufficiency with anuria, a dramatic increase in creatine phosphokinase (36000 U/L, n.v. 20-180 U/L) and myoglobin (> 120000 μg/L, n.v. 12-70 μg/L). On clinical examination, the patient showed increasing pain in the lower limbs associated with muscle weakness which was severe enough to immobilize her. Paraneoplastic myopathy linked to the malignant lesion of the pancreatic head was suspected. The patient was treated with hemodialysis and intravenous methylprednisolone. Despite all the efforts to prepare the patient for surgery, her general condition rapidly deteriorated and she eventually died 30 d after hospital admission. CONCLUSION The possible causes of rhabdomyolysis in this patient with pancreatic cancer are discussed, the development of paraneoplastic myopathy being the most likely. Clinicians should bear in mind that these syndromes may become clinically manifest at any stage of the cancer course and their early diagnosis and treatment could improve the patient's prognosis.
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Affiliation(s)
- Andrea Costantini
- Department of Surgical, Oncological and Gastroenterological Sciences, UOC Chirurgia Generale 1, University of Padua, Padua 35128, Italy
| | - Lucia Moletta
- Department of Surgical, Oncological and Gastroenterological Sciences, UOC Chirurgia Generale 1, University of Padua, Padua 35128, Italy
| | - Elisa Sefora Pierobon
- Department of Surgical, Oncological and Gastroenterological Sciences, UOC Chirurgia Generale 1, University of Padua, Padua 35128, Italy
| | - Simone Serafini
- Department of Surgical, Oncological and Gastroenterological Sciences, UOC Chirurgia Generale 2, University of Padua, Padua 35128, Italy
| | - Michele Valmasoni
- Department of Surgical, Oncological and Gastroenterological Sciences, UOC Chirurgia Generale 1, University of Padua, Padua 35128, Italy
| | - Cosimo Sperti
- Department of Surgical, Oncological and Gastroenterological Sciences, UOC Chirurgia Generale 2, University of Padua, Padua 35128, Italy
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Sun K, Shi Z, Abudureheman Y, Liu Q, Zhao Y, Zhang X, Lv Q, Zhang Y, Shou S, Jin H. Clinical and Epidemiological Characteristics of Rhabdomyolysis: A Retrospective Study. Int J Clin Pract 2023; 2023:6396576. [PMID: 37808625 PMCID: PMC10558265 DOI: 10.1155/2023/6396576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/11/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023] Open
Abstract
Background Rhabdomyolysis (RM) refers to a clinical syndrome in which muscle cells are damaged by various causes and the clinical manifestations are mainly muscle pain, weakness, and dark urine. Acute kidney injury (AKI) is a serious complication of RM with complex mechanisms and high mortality. Therefore, understanding the pathogenesis and clinical manifestations, early diagnosis and treatment of RM are crucial to improve its prognosis. Method Analysis of medical records of RM patients admitted to Tianjin Medical University General Hospital from October 2019 to October 2022. Statistical software SPSS 25.0 was used to analyze the data. The risk factors of RM-complicated AKI were analyzed by logistic regression. The receiver operating characteristic (ROC) curve was plotted, the area under the curve (AUC) was calculated, and the optimal cutoff value was determined by the Youden index. P < 0.05 indicates a statistically significant difference between the groups. Result Among the 71 patients, the median age of the patients was 53.0 (30.0, 71.0) years and was 2.5 times higher in men than in women. Infection was the most common etiology. History of alcohol consumption, CK, and creatinine were independent influencing factors for AKI due to RM. Logistic regression analysis showed that CK combined with creatinine had a better predictive value than the single index. Conclusion Our study revealed the clinical and laboratory characteristics of RM in the population attending the Tianjin Medical University General Hospital in the last three years, which is a reference for future multicenter, prospective studies.
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Affiliation(s)
- Keke Sun
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhenhua Shi
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
- Department of Intensive Care Unit, PLA 983rd Hospital, Tianjin, China
| | - Yushanjiang Abudureheman
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
- Department of Critical Care Medicine, Hotan District People's Hospital, Xinjiang, China
| | - Qihui Liu
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Yibo Zhao
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiangqun Zhang
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Qi Lv
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Yan Zhang
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Songtao Shou
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Heng Jin
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
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Al Khaldi T, Gulreez R, Abdelhamid MM, Louri N. Acute carbon monoxide poisoning as a cause of rhabdomyolysis in a case of flame burn. BMJ Case Rep 2023; 16:e236012. [PMID: 37202107 PMCID: PMC10201226 DOI: 10.1136/bcr-2020-236012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Carbon monoxide (CO) poisoning typically occurs from inhalation of CO at excessive levels. Rhabdomyolsis is not an uncommon complication following acute CO poisoning, yet there are very few reported cases in the literature. It is characterised by rapid breakdown of skeletal muscles and release of its contents into the circulation, leading to acute kidney injury (AKI). Early diagnosis and treatment are crucial to avoid anticipated morbidity and mortality. We are presenting a case of a woman in her 40s with 28% flame burn in a closed space. The patient developed CO poisoning, which led to rhabdomyolysis as evidenced by clinical manifestations and laboratory findings (creatine kinase had reached an unmeasurable level). The patient developed AKI and was successfully managed in our ICU. Here, we are highlighting the importance of considering CO poisoning as one of the potential causes of rhabdomyolysis in burn victim.
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Affiliation(s)
- Turki Al Khaldi
- Plastic Surgery and Burn, Bahrain Defence Force Royal Medical Services, Riffa, Bahrain
| | - Rasheeqa Gulreez
- Plastic Surgery, Bahrain Defence Force Royal Medical Services, Riffa, Bahrain
| | | | - Nayef Louri
- Plastic Surgery, Bahrain Defence Force Royal Medical Services, Riffa, Bahrain
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Abstract
A 76-year-old lady was found on the floor following a fall at home. She was uninjured, but unable to get up, and had been lying on the floor for roughly 18 hours before her son arrived. She had been unwell for the past 3 days with a cough and shortness of breath. She had a past medical history of diabetes, hypertension, hypercholesterolaemia and atrial fibrillation (AF). On examination, she was alert but distressed, clinically dehydrated, febrile and tachycardic. She was treated for community acquired pneumonia with co-amoxiclav and was fluid resuscitated with Hartmann's solution. Her hyperkalaemia was treated with 50 mL of 50% glucose containing 10 units of rapid-acting insulin. Her creatinine kinase (CK) on admission was 200,000, and she had an acute kidney injury (AKI). Urine dipstick was positive for blood. However, her renal function continued to deteriorate over the succeeding 48 h, when she required renal replacement therapy (RRT) due to fluid overload and anuria.
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Affiliation(s)
- Sarah Burgess
- Sarah Burgess, Department of Anaesthesia,
University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry
CV2 2DX, UK.
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Wendt S, Lübbert C, Begemann K, Prasa D, Franke H. Poisoning by Plants. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:arztebl.m2022.0124. [PMID: 35140011 PMCID: PMC9453220 DOI: 10.3238/arztebl.m2022.0124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/26/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Questions on poisoning by plants are a common reason for inquiries to poison information centers (PIC). Over the years 2011-2020, plant poisoning was the subject of 15% of all inquiries to the joint poison information center in Erfurt, Germany (Gemeinsames Giftinformationszentrum Erfurt, GGIZ) that concerned poisoning in children (2.3% in adults). In this patient collective, plant poisoning occupied third place after medical drugs (32%) and chemical substances (24%), and was a more common subject of inquiry than mushroom poisoning (1.5%). METHODS This review is based on pertinent publications retrieved by a selective literature search in PubMed/TOXLINE on plant poisoning and on 12 epidemiologically and toxicologically relevant domestic species of poisonous plants in risk categories 2 and 3 (up to 2021). RESULTS Medical personnel should have basic toxicological knowledge of the following highly poisonous plants: wolfsbane (aconitum), belladonna, angel's trumpet, cowbane (cicuta virosa), autumn crocus, hemlock, jimson weed, henbane, castor bean (ricinus), false hellebore, foxglove (digitalis), and European yew. The intoxication is evaluated on the basis of a structured history (the "w" questions) and the clinical manifestations (e.g., toxidromes). Special analysis is generally not readily available and often expensive and time-consuming. In case of poisoning, a poison information center should be contacted for plant identification, risk assessment, and treatment recommendations. Specimens of plant components and vomit should be obtained, if possible, for further testing. Measures for the elimination of the poisonous substance may be indicated after a risk-benefit analysis. Specific antidotes are available for only a few types of plant poisoning, e.g., physostigmine for tropane alkaloid poisoning or digitalis antibodies for foxglove poisoning. The treatment is usually symptomatic and only rarely evidence-based. Individualized medical surveillance is recommended after the ingestion of large or unknown quantities of poisonous plant components. CONCLUSION The clinician should be able to recognize dangerous domestic species of poisonous plants, take appropriate initial measures, and avoid overdiagnosis and overtreatment. To improve patient care, systematic epidemiological and clinical studies are needed.
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Affiliation(s)
- Sebastian Wendt
- Division of Infectious Diseases and Tropical Medicine, Department of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, University Hospital, Leipzig
- University Hospital Leipzig, Interdisciplinary Centre for Infectious Diseases (ZINF)
- Postgraduate Study of Toxicology and Environmental Protection, Leipzig
| | - Christoph Lübbert
- Division of Infectious Diseases and Tropical Medicine, Department of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, University Hospital, Leipzig
- University Hospital Leipzig, Interdisciplinary Centre for Infectious Diseases (ZINF)
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Hospital St. Georg, Leipzig
| | - Kathrin Begemann
- German Federal Institute for Risk Assessment, Department Exposure,Berlin
| | - Dagmar Prasa
- *These authors share last authorship
- Joint Poison Information Center of Mecklenburg-Vorpommern, Sachsen, Sachsen-Anhalt und Thüringen c/o HELIOS Klinikum Erfurt
| | - Heike Franke
- *These authors share last authorship
- Postgraduate Study of Toxicology and Environmental Protection, Leipzig
- Rudolf-Boehm-Institute of Pharmacology and Toxicology, University of Leipzig
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Svobodová E, Drábek T, Brodská H. Pervitin Intoxication with Two-peak Massive Myoglobinemia, Acute Kidney Injury and Marked Procalcitonin Increase Not Associated with Sepsis. Prague Med Rep 2022; 123:266-278. [PMID: 36416465 DOI: 10.14712/23362936.2022.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Patients intoxicated with methamphetamine-like substances may present with myoglobinuria but rarely require admission. An 18-year-old female was admitted due to intoxication with pervitin, a methamphetamine derivative. She presented with an altered mental status, fever, and increased heart and respiratory rates. Biomarkers showed leukocytosis and markedly increased procalcitonin levels, suggestive of sepsis. However, blood cultures and infectious disease workup were unrevealing. Clinical course was heralded by rhabdomyolysis and myoglobinuria resulting in multi-organ failure including respiratory failure necessitating mechanical ventilation, hemodynamic compromise with need for inotropic support, and an acute renal failure requiring renal replacement therapy. Surprisingly, after a transient improvement, an unexpected second peak of myoglobin was observed on hospital day 5, controlled by intensifying the elimination methods, and administration of dantrolene. Acute kidney injury resolved by hospital day 15, and the patient could be discharged on day 22. While most patients with intoxications are discharged within 24 hours from emergency departments without being admitted, our case report highlights that the organ injury may evolve beyond the usual observation period, traditional renal-replacement therapies may not be sufficient to mitigate myoglobinemia with resulting acute kidney injury, and that procalcitonin may not be a reliable biomarker of infection in the setting of drug-induced rhabdomyolysis.
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Yoo S, Cho MH, Baek HS, Song JY, Lee HS, Yang EM, Yoo KH, Kim SJ, Shin JI, Lee KH, Ha TS, Jang KM, Lee JW, Kim KH, Cho H, Lee MJ, Suh JS, Han KH, Hyun HS, Ha IS, Cheong HI, Kang HG, Namgoong MK, Cho HK, Oh JH, Lee ST, Kim KS, Lee JH, Park YS, Kim SH. Characteristics of pediatric rhabdomyolysis and the associated risk factors for acute kidney injury: a retrospective multicenter study in Korea. Kidney Res Clin Pract 2021; 40:673-686. [PMID: 34510859 PMCID: PMC8685356 DOI: 10.23876/j.krcp.21.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/20/2021] [Indexed: 11/28/2022] Open
Abstract
Background The clinical features of pediatric rhabdomyolysis differ from those of the adults with rhabdomyolysis; however, multicenter studies are lacking. This study aimed to investigate the characteristics of pediatric rhabdomyolysis and reveal the risk factors for acute kidney injury (AKI) in such cases. Methods This retrospective study analyzed the medical records of children and adolescents diagnosed with rhabdomyolysis at 23 hospitals in South Korea between January 2007 and December 2016. Results Among 880 patients, those aged 3 to 5 years old composed the largest subgroup (19.4%), and all age subgroups were predominantly male. The incidence of AKI was 11.3%. Neurological disorders (53.6%) and infection (39.0%) were the most common underlying disorder and cause of rhabdomyolysis, respectively. The median age at diagnosis in the AKI subgroup was older than that in the non-AKI subgroup (12.2 years vs. 8.0 years). There were no significant differences in body mass index, myalgia, dark-colored urine, or the number of causal factors between the two AKI-status subgroups. The multivariate logistic regression model indicated that the following factors were independently associated with AKI: multiorgan failure, presence of an underlying disorder, strong positive urine occult blood, increased aspartate aminotransferase and uric acid levels, and reduced calcium levels. Conclusions Our study revealed characteristic clinical and laboratory features of rhabdomyolysis in a Korean pediatric population and highlighted the risk factors for AKI in these cases. Our findings will contribute to a greater understanding of pediatric rhabdomyolysis and may enable early intervention against rhabdomyolysis-induced AKI.
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Affiliation(s)
- Sukdong Yoo
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Min Hyun Cho
- Department of Pediatrics, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Hee Sun Baek
- Department of Pediatrics, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Ji Yeon Song
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Hye Sun Lee
- Department of Pediatrics, National Police Hospital, Seoul, Republic of Korea
| | - Eun Mi Yang
- Department of Pediatrics, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kee Hwan Yoo
- Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Su Jin Kim
- Department of Pediatrics, Inha University School of Medicine, Incheon, Republic of Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Sun Ha
- Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Kyung Mi Jang
- Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Jung Won Lee
- Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Kee Hyuck Kim
- Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Goyang, Republic of Korea
| | - Heeyeon Cho
- Department of Pediatrics, Samsung Medical Center, Seoul, Republic of Korea
| | - Mee Jeong Lee
- Department of Pediatrics, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Jin-Soon Suh
- Department of Pediatrics, The Catholic University of Korea, Bucheon Saint Mary's Hospital, Bucheon, Republic of Korea
| | - Kyoung Hee Han
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Hye Sun Hyun
- Department of Pediatrics, The Catholic University of Korea, Saint Vincent's Hospital, Suwon, Republic of Korea
| | - Il-Soo Ha
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hae Il Cheong
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Mee Kyung Namgoong
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Hye-Kyung Cho
- Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jae-Hyuk Oh
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sang Taek Lee
- Department of Pediatrics, Samsung Changwon Hospital, Changwon, Republic of Korea
| | - Kyo Sun Kim
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Joo Hoon Lee
- Department of Pediatrics, Children's Hospital, Asan Medical Center, Seoul, Republic of Korea
| | - Young Seo Park
- Department of Pediatrics, Children's Hospital, Asan Medical Center, Seoul, Republic of Korea
| | - Seong Heon Kim
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Republic of Korea
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Desgrouas M, Boulain T. Paracetamol use and lowered risk of acute kidney injury in patients with rhabdomyolysis. J Nephrol 2021; 34:1725-1735. [PMID: 33400139 DOI: 10.1007/s40620-020-00950-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/07/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mortality with rhabdomyolysis-associated acute kidney injury can be as high as 80%. Experimental data from mouse models of rhabdomyolysis showed that paracetamol reduces the expected increase in serum creatinine level. We aimed to assess the association between paracetamol use and the need for starting renal replacement therapy (RRT). METHODS We conducted a propensity score-matched cohort study in Orléans Hospital, France (a 1136-bed, public, university-affiliated and teaching hospital). All patients with serum creatine phosphokinase (CK) level > 5000 IU/L between January 1st, 2008 and December 31st, 2017 were included. A propensity score was calculated for each included patient by using multivariable logistic regression and all available baseline characteristics. The main outcome was the incidence of RRT initiation from day 1 to day 28 in the propensity score-matched cohort between patients exposed and unexposed to paracetamol. RESULTS Over the study period, 1065 patients with at least one CK level measurement > 5000 IU/L were included; 40 (3.8%) had at least one RRT session. Among the 343 matched pairs, 10 (2.9%) exposed and 24 (7.0%) unexposed patients underwent RRT before day 28 (P = 0.021). Primary time-to-event analysis showed that exposure to paracetamol was significantly associated with reduced absolute risk of RRT: absolute risk difference = - 3.18% (95% CI - 5.23 to - 1.20, P = 0.001). All secondary analyses showed a significantly reduced absolute risk of RRT in patients exposed to paracetamol. CONCLUSION Our study showed a significant association between paracetamol exposure and reduced incidence of RRT among patients with rhabdomyolysis.
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Affiliation(s)
- Maxime Desgrouas
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, 14 avenue de l'hôpital, 45100, Orléans, France
| | - Thierry Boulain
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, 14 avenue de l'hôpital, 45100, Orléans, France.
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Lim AKH, Azraai M, Pham JH, Looi WF, Bennett C. The Association Between Illicit Drug Use and the Duration of Renal Replacement Therapy in Patients With Acute Kidney Injury From Severe Rhabdomyolysis. Front Med (Lausanne) 2020; 7:588114. [PMID: 33240909 PMCID: PMC7680872 DOI: 10.3389/fmed.2020.588114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background and Aims: Acute kidney injury is a known complication of severe rhabdomyolysis. In patients who present to hospital with rhabdomyolysis, illicit drug use is associated with a higher risk of acute kidney injury needing renal replacement therapy (RRT), independent of the peak serum creatine kinase level. The aim of this study was to assess if RRT duration and renal outcomes were also worse in illicit drug use-associated rhabdomyolysis. Methods: We conducted a cohort study of adult patients who presented to Monash Health (Jan 2011–June 2020) with rhabdomyolysis and required RRT. Patients with isolated myocardial injury and cardiac arrest were excluded. We used survival analysis to examine the time to RRT independence, utilizing the Fine-Gray competing risks regression and death as the competing event. A subdistribution hazard ratio (SHR) < 1.0 represents a relatively greater duration of RRT and a worse outcome. Results: We included 101 patients with a mean age of 58 years, of which 17% were cases associated with illicit drug use. The median peak creatine kinase level was 5,473 U/L (interquartile range, 1,795–17,051 U/L). Most patients (79%) initiated RRT within 72 h of admission, at a median serum creatinine of 537 μmol/L (interquartile range, 332–749 μmol/L). In the competing risks analysis, the estimated SHR was 1.48 (95% CI: 0.78–2.84, P = 0.23) for illicit drug use, 0.87 (95% CI: 0.76–0.99, P = 0.041) for the log-transformed peak creatine kinase, and 0.41 (95% CI: 0.25–0.67, P < 0.001) for sepsis. A 50% cumulative incidence of RRT independence occurred at 11 days (95% CI: 8–16 days). Only 5% of patients remained on RRT at 3 months. Conclusion: In rhabdomyolysis-associated acute kidney injury, it is unlikely that patients with illicit drug use-associated rhabdomyolysis require a longer duration of RRT compared to patients with rhabdomyolysis from other causes.
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Affiliation(s)
- Andy K. H. Lim
- Department of General Medicine, Monash Health, Clayton, VIC, Australia
- Department of Nephrology, Monash Health, Clayton, VIC, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
- *Correspondence: Andy K. H. Lim
| | - Meor Azraai
- Department of General Medicine, Monash Health, Clayton, VIC, Australia
| | - Jeanette H. Pham
- Department of General Medicine, Monash Health, Clayton, VIC, Australia
| | - Wenye F. Looi
- Department of General Medicine, Monash Health, Clayton, VIC, Australia
| | - Caitriona Bennett
- Department of General Medicine, Monash Health, Clayton, VIC, Australia
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Cote DR, Fuentes E, Elsayes AH, Ross JJ, Quraishi SA. A "crush" course on rhabdomyolysis: risk stratification and clinical management update for the perioperative clinician. J Anesth 2020; 34:585-598. [PMID: 32424487 DOI: 10.1007/s00540-020-02792-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 05/09/2020] [Indexed: 12/14/2022]
Abstract
Rhabdomyolysis, the release of myoglobin and other cellular breakdown products from necrotic muscle tissue, is seen in patients with crush injuries, drug overdose, malignant hyperthermia, muscular dystrophy, and with increasing frequency in obese patients undergoing routine procedures. For the perioperative clinician, managing the resultant shock, hyperkalemia, acidosis, and myoglobinuric acute kidney injury can present a significant challenge. Prompt recognition, hydration, and correction of metabolic disturbances may reduce or eliminate the need for long-term renal replacement therapy. This article reviews the pathophysiology and discusses key issues in the perioperative diagnosis, risk stratification, and management of rhabdomyolysis.
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Affiliation(s)
- Devan R Cote
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Eva Fuentes
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Ali H Elsayes
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA
| | - Jonathan J Ross
- Department of Anesthesiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
| | - Sadeq A Quraishi
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA.
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Ding LN, Wang Y, Tian J, Ye LF, Chen S, Wu SM, Shang WB. Primary hypoparathyroidism accompanied by rhabdomyolysis induced by infection: A case report. World J Clin Cases 2019; 7:3111-3119. [PMID: 31624762 PMCID: PMC6795733 DOI: 10.12998/wjcc.v7.i19.3111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/12/2019] [Accepted: 09/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Primary hypoparathyroidism (HPT) is rarely seen in the clinic, and it can be combined with rhabdomyolysis. There are few reports about this phenomenon. Therefore, it is significant to explore the etiology that is conducive to early diagnosis, timely treatment, and preventing the recurrence.
CASE SUMMARY A 63-year-old man was admitted to our hospital with a severe upper respiratory tract infection and progressing decreased myodynamia of the lower limbs. Blood tests showed creatine kinase > 32000 U/L, creatinine 207.8 µmol/L, calcium 1.28 mmol/L, myoglobin 558.7 ng/mL, and parathyroid hormone 0 pg/mL. He was diagnosed with primary HPT with rhabdomyolysis, and severe upper respiratory tract infection was considered to be the initial trigger. He responded well to supplementation of intravenous calcium gluconate and oral calcium as well as bedside hemodialysis, fluid hydration, infection control, protecting the liver, etc. Creatine kinase, myoglobin, and serum calcium returned to normal, and muscle strength improved significantly. Symptoms improved after symptomatic treatment.
CONCLUSION Severe infection should be prevented, which is the key cause of rhabdomyolysis in patients with HPT.
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Affiliation(s)
- Li-Na Ding
- Department of Endocrinology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Yi Wang
- Department of Endocrinology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Jun Tian
- Department of General Surgery, Zhangjiagang Traditional Chinese Medicine Hospital affiliated with Nanjing University of Chinese Medicine, Zhangjiagang 215600, Jiangsu Province, China
| | - Li-Fang Ye
- Department of Endocrinology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Shi Chen
- Department of Endocrinology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Shi-Min Wu
- Department of Gynecology and Obstetrics, Changshu Traditional Chinese Medicine Hospital affiliated with Nanjing University of Chinese Medicine, Changshu 215500, Jiangsu Province, China
| | - Wen-Bin Shang
- Department of Endocrinology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
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Huang R, Shi M, Guo F, Feng Y, Feng Y, Liu J, Li L, Liang Y, Xiang J, Lei S, Ma L, Fu P. Pharmacological Inhibition of Fatty Acid-Binding Protein 4 (FABP4) Protects Against Rhabdomyolysis-Induced Acute Kidney Injury. Front Pharmacol 2018; 9:917. [PMID: 30135658 PMCID: PMC6092613 DOI: 10.3389/fphar.2018.00917] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/26/2018] [Indexed: 02/05/2023] Open
Abstract
Acute kidney injury (AKI) is a common and potentially life-threatening complication. Studies confirmed that circulating FABP4 depended on renal function of AKI patients. In our previous study, FABP4 was involved in the pathogenesis of I/R-induced AKI. However, the function of FABP4 in rhabdomyolysis-induced AKI remained poorly understood. In the study, we further investigated the effect of FABP4 in a murine model of glycerol injection-induced rhabdomyolysis. Following glycerol injection, the mice developed severe AKI as indicated by acute renal dysfunction and histologic changes, companied by the increased FABP4 expression in the cytoplasm of tubular epithelial cells. Pharmacological inhibition of FABP4 by a highly selective inhibitor BMS309403 significantly reduced serum creatinine level, proinflammatory cytokine mRNA expression of tumor necrosis factor-α, interleukin-6, and monocyte chemoattractant protein 1 as well as attenuated renal tubular damage in glycerol-injured kidneys. Oral administration of FABP4 inhibitor also resulted in a significant attenuation of ER stress indicated by transmission electron microscope analysis and its maker proteins expression of GRP78, CHOP, p-perk, and ATF4 in kidneys of AKI. Furthermore, BMS309403 could attenuate myoglobin-induced ER stress and inflammation in renal proximal tubular epithelial cell line (HK-2). Overall, these data highlighted that renal protection of selective FABP4 inhibitor was substantiated by the reduction of ER stress and inflammation in tubular epithelial cells of rhabdomyolysis-induced injured kidneys and suggested that the inhibition of FABP4 might be a promising therapeutic strategy for AKI treatment.
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Affiliation(s)
- Rongshuang Huang
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Min Shi
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Fan Guo
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Yuying Feng
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Yanhuan Feng
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Jing Liu
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Lingzhi Li
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Yan Liang
- Core Facility of West China Hospital, Chengdu, China
| | - Jin Xiang
- Laboratory of Clinical Pharmacology, West China Hospital of Sichuan University, Chengdu, China
| | - Song Lei
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, China
| | - Liang Ma
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Ping Fu
- Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
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Gille J, Schmidt T, Dragu A, Emich D, Hilbert-Carius P, Kremer T, Raff T, Reichelt B, Siafliakis A, Siemers F, Steen M, Struck MF. Electrical injury - a dual center analysis of patient characteristics, therapeutic specifics and outcome predictors. Scand J Trauma Resusc Emerg Med 2018; 26:43. [PMID: 29855384 PMCID: PMC5984367 DOI: 10.1186/s13049-018-0513-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/21/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Electrical injuries represent life-threatening emergencies. Evidence on differences between high (HVI) and low voltage injuries (LVI) regarding characteristics at presentation, rhabdomyolysis markers, surgical and intensive burn care and outcomes is scarce. METHODS Consecutive patients admitted to two burn centers for electrical injuries over an 18-year period (1998-2015) were evaluated. Analysis included comparisons of HVI vs. LVI regarding demographic data, diagnostic and treatment specific variables, particularly serum creatinine kinase (CK) and myoglobin levels over the course of 4 post injury days (PID), and outcomes. RESULTS Of 4075 patients, 162 patients (3.9%) with electrical injury were analyzed. A total of 82 patients (50.6%) were observed with HVI. These patients were younger, had considerably higher morbidity and mortality, and required more extensive burn surgery and more complex burn intensive care than patients with LVI. Admission CK and myoglobin levels correlated significantly with HVI, burn size, ventilator days, surgical interventions, amputation, flap surgery, renal replacement therapy, sepsis, and mortality. The highest serum levels were observed at PID 1 (myoglobin) and PID 2 (CK). In 23 patients (14.2%), cardiac arrhythmias were observed; only 4 of these arrhythmias occurred after hospital admission. The independent predictors of mortality were ventilator days (OR 1.27, 95% CI 1.06-1.51, p = 0.009), number of surgical interventions (OR 0.47, 95% CI 0.27-0.834, p = 0.010) and limb amputations (OR 14.26, 95% CI 1.26-162.1, p = 0.032). CONCLUSIONS Patients with electrical injuries, HVI in particular, are at high risk for severe complications. Due to the need for highly specialized surgery and intensive care, treatment should be reserved to burn units. Serum myoglobin and CK levels reflect the severity of injury and may predict a more complex clinical course. Routine cardiac monitoring > 24 h post injury does not seem to be necessary.
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Affiliation(s)
- Jochen Gille
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, St. Georg Hospital, Delitzscher Str. 141, 04129, Leipzig, Germany
| | - Thomas Schmidt
- Department of Medical Psychology, Bergmannstrost Hospital, Merseburger Str. 165, 06112, Halle, Germany
| | - Adrian Dragu
- Department of Plastic and Hand Surgery, Burn Center, St. Georg Hospital, Delitzscher Str. 141, 04129, Leipzig, Germany.,Department of Plastic and Hand Surgery, University Center of Orthopedics and Trauma Surgery, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Germany
| | - Dimitri Emich
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, St. Georg Hospital, Delitzscher Str. 141, 04129, Leipzig, Germany
| | - Peter Hilbert-Carius
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Bergmannstrost Hospital, Merseburger Str. 165, 06112, Halle, Germany
| | - Thomas Kremer
- Department of Plastic and Hand Surgery, Burn Center, St. Georg Hospital, Delitzscher Str. 141, 04129, Leipzig, Germany
| | - Thomas Raff
- Department of Plastic and Hand Surgery, Burn Center, St. Georg Hospital, Delitzscher Str. 141, 04129, Leipzig, Germany
| | - Beate Reichelt
- Department of Plastic and Hand Surgery, Burn Center, Bergmannstrost Hospital, Merseburger Str. 165, 06112, Halle, Germany
| | - Apostolos Siafliakis
- Department of Plastic and Hand Surgery, Burn Center, Bergmannstrost Hospital, Merseburger Str. 165, 06112, Halle, Germany
| | - Frank Siemers
- Department of Plastic and Hand Surgery, Burn Center, Bergmannstrost Hospital, Merseburger Str. 165, 06112, Halle, Germany
| | - Michael Steen
- Department of Plastic and Hand Surgery, Burn Center, Bergmannstrost Hospital, Merseburger Str. 165, 06112, Halle, Germany
| | - Manuel F Struck
- Department of Plastic and Hand Surgery, Burn Center, Bergmannstrost Hospital, Merseburger Str. 165, 06112, Halle, Germany. .,Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
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14
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Ho CWG, Yang SH, Wong CH, Chong SJ. High-voltage electrical injury complicated by compartment syndrome and acute kidney injury with successful limb salvage: A case report and review of the literature. Int J Surg Case Rep 2018; 48:38-42. [PMID: 29787959 PMCID: PMC6026718 DOI: 10.1016/j.ijscr.2018.04.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 04/30/2018] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Although an uncommon form of admission to a burns centre, the deep, penetrating nature of noxious currents mean that electrical burns have the most catastrophic consequences of all burn injuries. Understanding the physics of electricity is crucial to explaining the mechanisms of tissue damage and organ failure in electrical injuries which necessitate special management above and beyond that of regular thermal burns. PRESENTATION OF CASE We present a young man who suffered significant occupation-related electrical burns that was complicated by compartment syndrome, rhabdomyolysis and acute kidney injury. He required multiple surgeries (including fasciotomy as well as soft tissue reconstruction), critical care and lengthy rehabilitation. DISCUSSION Rhabdomyolysis is common sequela of electrical burns and may result in severe and permanent metabolic and renal impairment. High cut-off dialysis membranes have shown great promise in myoglobin removal but further studies are required to determine whether this improves clinical outcomes. Debridement and decompression are the cornerstones of initial surgical intervention and are crucial to minimising infectious complications and preserving vital structures. Free tissue transfer has become increasingly popular, but the ideal timing of microsurgery is still uncertain. Nonetheless, pedicled flaps remain widely used and still have an important role in reconstruction of electrical burns. CONCLUSION Patients with electrical injuries have several unique acute manifestations that differ from other burns. Prognosticating outcomes is difficult, as the full scale of damage is seldom immediately evident. Multiple organ systems are often affected, which makes the treatment of such patients exceptionally challenging, multi-disciplinary and resource-intensive.
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Affiliation(s)
- Christopher Wei Guang Ho
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road Singapore, 169608, Singapore.
| | - Shi-Hui Yang
- Department of General Surgery, Singapore General Hospital, Outram Road Singapore, 169608, Singapore.
| | - Chu Hui Wong
- Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road Singapore, 229899, Singapore.
| | - Si Jack Chong
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road Singapore, 169608, Singapore.
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15
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Lim YS, Cho H, Lee ST, Lee Y. Acute kidney injury in pediatric patients with rhabdomyolysis. KOREAN JOURNAL OF PEDIATRICS 2018; 61:95-100. [PMID: 29628970 PMCID: PMC5876511 DOI: 10.3345/kjp.2018.61.3.95] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/13/2017] [Accepted: 10/17/2017] [Indexed: 12/18/2022]
Abstract
Purpose This study aimed to evaluate the clinical findings in pediatric rhabdomyolysis and the predictive factors for acute kidney injury (AKI) in Korean children. Methods Medical records of 39 Korean children, who were newly diagnosed with rhabdomyolysis from January 2008 to December 2015, were retrospectively analyzed. The diagnosis was made from the medical history, elevated serum creatinine kinase level >1,000 IU/L, and plasma myoglobin level >150 ng/mL. Patients with muscular dystrophy and myocardial infarction were excluded. Results The median patient age at diagnosis was 14.0 years (range, 3–18 years), and the male to female ratio was 2.5. The most common presenting symptom was myalgia (n=25, 64.1%), and 14 patients (35.9%) had rhabdomyolysis-induced AKI. Eighteen patients (46.2%) had underlying diseases, such as epilepsy and psychotic disorders. Ten of these patients showed rhabdomyolysis-induced AKI. The common causes of rhabdomyolysis were infection (n=12, 30.7%), exercise (n=9, 23.1%), and trauma (n=8, 20.5%). There was no difference in the distribution of etiology between AKI and non-AKI groups. Five patients in the AKI group showed complete recovery of renal function after stopping renal replacement therapy. The median length of hospitalization was 7.0 days, and no mortality was reported. Compared with the non-AKI group, the AKI group showed higher levels of peak creatinine kinase and myoglobin, without statistical significance. Conclusion The clinical characteristics of pediatric rhabdomyolysis differ from those observed in adult patients. Children with underlying diseases are more vulnerable to rhabdomyolysis-induced AKI. AKI more likely develops in the presence of a high degree of albuminuria.
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Affiliation(s)
- Young Shin Lim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heeyeon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Taek Lee
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Yeonhee Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Wang F, Hong D, Wang Y, Feng Y, Wang L, Yang L. Renal replacement therapy in acute kidney injury from a Chinese cross-sectional study: patient, clinical, socioeconomic and health service predictors of treatment. BMC Nephrol 2017; 18:152. [PMID: 28472927 PMCID: PMC5418849 DOI: 10.1186/s12882-017-0567-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 04/22/2017] [Indexed: 01/20/2023] Open
Abstract
Background Renal replacement therapy (RRT) is important to support critically ill patients with acute kidney injury (AKI). This study, a part of a nation-wide survey for AKI conducted by the ISN AKF 0 by 25 China Consortium, aims to study the current RRT practical situation and problems in China. Methods The current study is a part of a nation-wide survey for AKI conducted by ISN AKF 0 by 25 China Consortium. The survey included 44 sites all over the country, including 22 academic hospitals in big cities and 22 local hospitals in smaller cities or rural areas. Of the 44 sites, all have access to PD and IHD, 93.5% are capable to perform CRRT. Of total 7604 AKI cases, 896 cases (11.8%) had indications for RRT and were included in the current abstract. Results of the 896 patients that had indications for RRT, only 59.3% received RRT. Patients who were older, male, from lower income areas, in local hospitals, or with severe comorbidities, were less likely to receive RRT. RRT treatment was associated with lower mortality (OR = 0.58, 95%CI 0.38–0.89). The RRT modalities were continuous renal replacement therapy (CRRT) in 53.9%, intermittent hemodialysis (IHD) in 38.0%, CRRT complemented by IHD in 6.2%, CRRT complemented by peritoneal dialysis (PD) in 0.8% and PD in 1.1%. Of the subgroup of patients receiving RRT who did not have an indication for modality of CRRT, 36.8% in fact received CRRT, and their medical cost and mortality rate was higher (7944[4248, 16,055] vs. 5100[2948, 9396] US dollars, p < 0.001 and 10.6% vs. 4.4%, p = 0.047, respectively) compared with those treated with other RRT modalities). Conclusions Extrapolated to the whole of China our results indicate that an estimated 139,000 patients with an indication of RRT are under treated without RRT over a year. Non-clinical factors influence RRT prescription for severe AKI patients. CRRT may be over-utilized in the treatment of severe AKI and the use of PD is extremely rare. These findings have implications for the effective application of medical resources in the treatment of severe AKI.
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Affiliation(s)
- Fang Wang
- Division of Nephrology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Daqing Hong
- Division of Nephrology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Yafang Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034, People's Republic of China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, People's Republic of China
| | - Yunlin Feng
- Division of Nephrology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Li Wang
- Division of Nephrology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China.
| | - Li Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034, People's Republic of China. .,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, People's Republic of China.
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Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:135. [PMID: 27301374 PMCID: PMC4908773 DOI: 10.1186/s13054-016-1314-5] [Citation(s) in RCA: 206] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Rhabdomyolysis is a clinical syndrome that comprises destruction of skeletal muscle with outflow of intracellular muscle content into the bloodstream. There is a great heterogeneity in the literature regarding definition, epidemiology, and treatment. The aim of this systematic literature review was to summarize the current state of knowledge regarding the epidemiologic data, definition, and management of rhabdomyolysis. Methods A systematic search was conducted using the keywords “rhabdomyolysis” and “crush syndrome” covering all articles from January 2006 to December 2015 in three databases (MEDLINE, SCOPUS, and ScienceDirect). The search was divided into two steps: first, all articles that included data regarding definition, pathophysiology, and diagnosis were identified, excluding only case reports; then articles of original research with humans that reported epidemiological data (e.g., risk factors, common etiologies, and mortality) or treatment of rhabdomyolysis were identified. Information was summarized and organized based on these topics. Results The search generated 5632 articles. After screening titles and abstracts, 164 articles were retrieved and read: 56 articles met the final inclusion criteria; 23 were reviews (narrative or systematic); 16 were original articles containing epidemiological data; and six contained treatment specifications for patients with rhabdomyolysis. Conclusion Most studies defined rhabdomyolysis based on creatine kinase values five times above the upper limit of normal. Etiologies differ among the adult and pediatric populations and no randomized controlled trials have been done to compare intravenous fluid therapy alone versus intravenous fluid therapy with bicarbonate and/or mannitol.
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Watson JDB, Gifford SM, Clouse WD. Biochemical markers of acute limb ischemia, rhabdomyolysis, and impact on limb salvage. Semin Vasc Surg 2014; 27:176-81. [DOI: 10.1053/j.semvascsurg.2015.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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