1
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Zhao W, Wang YP, Tang X, Jiang Y, Xue Y, Wang Y, Ding Q, Chen H, Wang D, Cheng Y, Ge M, Zhou Q. Development and validation of LCMM prediction algorithms to estimate recovery pattern of postoperative AKI in type A aortic dissection: a retrospective study. Front Cardiovasc Med 2024; 11:1364332. [PMID: 38707890 PMCID: PMC11066321 DOI: 10.3389/fcvm.2024.1364332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
Background Postoperative acute kidney injury (PO-AKI) is a prevalent complication among patients with acute type A aortic dissection (aTAAD) for which unrecognized trajectories of renal function recovery, and their heterogeneity, may underpin poor success in identifying effective therapies. Methods This was a retrospective, single-center cohort study in a regional Great Vessel Center including patients undergoing aortic dissection surgery. Estimated glomerular filtration rate (eGFR) recovery trajectories of PO-AKI were defined through the unsupervised latent class mixture modeling (LCMM), with an assessment of patient and procedural characteristics, complications, and early-term survival. Internal validation was performed by resampling. Results A total of 1,295 aTAAD patients underwent surgery and 645 (49.8%) developed PO-AKI. Among the PO-AKI cohort, the LCMM identified two distinct eGFR trajectories: early recovery (ER-AKI, 51.8% of patients) and late or no recovery (LNR-AKI, 48.2% of patients). Binary logistic regression identified five critical determinants regarding poor renal recovery, including chronic kidney disease (CKD) history, renal hypoperfusion, circulation arrest time, intraoperative urine, and myoglobin. LNR-AKI was associated with increased mortality, continuous renal replacement therapies, mechanical ventilation, ICU stay, and hospital stay. The assessment of the predictive model was good, with an area under the curve (AUC) of 0.73 (95% CI: 0.69-0.76), sensitivity of 61.74%, and specificity of 75.15%. The internal validation derived a consistent average AUC of 0.73. The nomogram was constructed for clinicians' convenience. Conclusion Our study explored the PO-AKI recovery patterns among surgical aTAAD patients and identified critical determinants that help to predict individuals at risk of poor recovery of renal function.
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Affiliation(s)
- Weiwei Zhao
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Ya-peng Wang
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, China
| | - Xinlong Tang
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Yi Jiang
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, China
| | - Yunxing Xue
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Yali Wang
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Qiuju Ding
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Huimei Chen
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore, Singapore
| | - Dongjin Wang
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - YongQing Cheng
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Min Ge
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Qing Zhou
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
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2
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Ikeda-Imafuku M, Fukuta T, Tuan Giam Chuang V, Sawa T, Maruyama T, Otagiri M, Ishida T, Ishima Y. Acute Kidney Injury Caused by Rhabdomyolysis Is Ameliorated by Serum Albumin-Based Supersulfide Donors through Antioxidative Pathways. Pharmaceuticals (Basel) 2024; 17:128. [PMID: 38256961 PMCID: PMC10819804 DOI: 10.3390/ph17010128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/24/2024] Open
Abstract
Oxidative stress is responsible for the onset and progression of various kinds of diseases including rhabdomyolysis-induced acute kidney injury (AKI). Antioxidants are, therefore, thought to aid in the recovery of illnesses linked to oxidative stress. Supersulfide species have been shown to have substantial antioxidative activity; however, due to their limited bioavailability, few supersulfide donors have had their actions evaluated in vivo. In this study, human serum albumin (HSA) and N-acetyl-L-cysteine polysulfides (NACSn), which have polysulfides in an oxidized form, were conjugated to create a supersulfide donor. HSA is chosen to be a carrier of NACSn because of its extended blood circulation and high level of biocompatibility. In contrast to a supersulfide donor containing reduced polysulfide in HSA, the NACSn-conjugated HSAs exhibited stronger antioxidant activity than HSA and free NACSn without being uptaken by the cells in vitro. The supersulfide donor reduced the levels of blood urea nitrogen and serum creatinine significantly in a mouse model of rhabdomyolysis-induced AKI. Supersulfide donors significantly reduced the expression of oxidative stress markers in the kidney. These results indicate that the developed supersulfide donor has the therapeutic effect on rhabdomyolysis-induced AKI.
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Affiliation(s)
- Mayumi Ikeda-Imafuku
- Department of Physical Pharmaceutics, School of Pharmaceutical Science, Wakayama Medical University, 25-1 Shichibancho, Wakayama 640-8156, Japan; (M.I.-I.); (T.F.)
- Department of Pharmacokinetics and Biopharmaceutics, Institute of Biomedical Sciences, Tokushima University, 1-78-1 Sho-machi, Tokushima 770-8505, Japan;
| | - Tatsuya Fukuta
- Department of Physical Pharmaceutics, School of Pharmaceutical Science, Wakayama Medical University, 25-1 Shichibancho, Wakayama 640-8156, Japan; (M.I.-I.); (T.F.)
| | - Victor Tuan Giam Chuang
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth 6845, Australia;
| | - Tomohiro Sawa
- Department of Microbiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan;
| | - Toru Maruyama
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Kumamoto 862-0973, Japan;
| | - Masaki Otagiri
- Faculty of Pharmaceutical Sciences, Sojo University, 4-22-1 Ikeda, Kumamoto 860-0082, Japan;
| | - Tatsuhiro Ishida
- Department of Pharmacokinetics and Biopharmaceutics, Institute of Biomedical Sciences, Tokushima University, 1-78-1 Sho-machi, Tokushima 770-8505, Japan;
| | - Yu Ishima
- Department of Pharmacokinetics and Biopharmaceutics, Institute of Biomedical Sciences, Tokushima University, 1-78-1 Sho-machi, Tokushima 770-8505, Japan;
- Laboratory of Biopharmaceutics, Kyoto Pharmaceutical University 5 Nakauchi-cho, Misasagi, Yamashina-ku, Kyoto 607-8414, Japan
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3
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Grange C, Lux F, Brichart T, David L, Couturier A, Leaf DE, Allaouchiche B, Tillement O. Iron as an emerging therapeutic target in critically ill patients. Crit Care 2023; 27:475. [PMID: 38049866 PMCID: PMC10694984 DOI: 10.1186/s13054-023-04759-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/24/2023] [Indexed: 12/06/2023] Open
Abstract
The multiple roles of iron in the body have been known for decades, particularly its involvement in iron overload diseases such as hemochromatosis. More recently, compelling evidence has emerged regarding the critical role of non-transferrin bound iron (NTBI), also known as catalytic iron, in the care of critically ill patients in intensive care units (ICUs). These trace amounts of iron constitute a small percentage of the serum iron, yet they are heavily implicated in the exacerbation of diseases, primarily by catalyzing the formation of reactive oxygen species, which promote oxidative stress. Additionally, catalytic iron activates macrophages and facilitates the growth of pathogens. This review aims to shed light on this underappreciated phenomenon and explore the various common sources of NTBI in ICU patients, which lead to transient iron dysregulation during acute phases of disease. Iron serves as the linchpin of a vicious cycle in many ICU pathologies that are often multifactorial. The clinical evidence showing its detrimental impact on patient outcomes will be outlined in the major ICU pathologies. Finally, different therapeutic strategies will be reviewed, including the targeting of proteins involved in iron metabolism, conventional chelation therapy, and the combination of renal replacement therapy with chelation therapy.
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Affiliation(s)
- Coralie Grange
- MexBrain, 13 Avenue Albert Einstein, Villeurbanne, France
- Institut Lumière-Matière, UMR 5306, Université Claude Bernard Lyon1-CNRS, Villeurbanne Cedex, France
| | - François Lux
- Institut Lumière-Matière, UMR 5306, Université Claude Bernard Lyon1-CNRS, Villeurbanne Cedex, France.
- Institut Universitaire de France (IUF), 75231, Paris, France.
| | | | - Laurent David
- Institut National des Sciences Appliquées, CNRS UMR 5223, Ingénierie des Matériaux Polymères, Univ Claude Bernard Lyon 1, Université Jean Monnet, 15 bd Latarjet, 69622, Villeurbanne, France
| | - Aymeric Couturier
- MexBrain, 13 Avenue Albert Einstein, Villeurbanne, France
- Nephrology, American Hospital of Paris, Paris, France
| | - David E Leaf
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Bernard Allaouchiche
- University of Lyon, University Lyon I Claude Bernard, APCSe VetAgro Sup UP, 2021. A10, Marcy L'Étoile, France
| | - Olivier Tillement
- Institut Lumière-Matière, UMR 5306, Université Claude Bernard Lyon1-CNRS, Villeurbanne Cedex, France
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4
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Haller N, Behringer M, Reichel T, Wahl P, Simon P, Krüger K, Zimmer P, Stöggl T. Blood-Based Biomarkers for Managing Workload in Athletes: Considerations and Recommendations for Evidence-Based Use of Established Biomarkers. Sports Med 2023; 53:1315-1333. [PMID: 37204619 PMCID: PMC10197055 DOI: 10.1007/s40279-023-01836-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 05/20/2023]
Abstract
Blood-based biomarkers can provide an objective individualized measure of training load, recovery, and health status in order to reduce injury risk and maximize performance. Despite enormous potentials, especially owing to currently evolving technology, such as point-of-care testing, and advantages, in terms of objectivity and non-interference with the training process, there are several pitfalls in the use and interpretation of biomarkers. Confounding variables such as preanalytical conditions, inter-individual differences, or an individual chronic workload can lead to variance in resting levels. In addition, statistical considerations such as the detection of meaningful minimal changes are often neglected. The lack of generally applicable and individual reference levels further complicates the interpretation of level changes and thus load management via biomarkers. Here, the potentials and pitfalls of blood-based biomarkers are described, followed by an overview of established biomarkers currently used to support workload management. Creatine kinase is discussed in terms of its evidence for workload management to illustrate the limited applicability of established markers for workload management to date. We conclude with recommendations for best practices in the use and interpretation of biomarkers in a sport-specific context.
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Affiliation(s)
- Nils Haller
- Department of Sports Medicine, Rehabilitation and Disease Prevention, Johannes Gutenberg University of Mainz, Mainz, Germany
- Department of Sport and Exercise Science, University of Salzburg, Schlossallee 49, Salzburg, 5400 Hallein-Rif, Austria
| | - Michael Behringer
- Department of Sports Sciences, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Thomas Reichel
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Science, Justus-Liebig-University Gießen, Gießen, Germany
| | - Patrick Wahl
- Department of Exercise Physiology, German Sport University Cologne, Cologne, Germany
| | - Perikles Simon
- Department of Sports Medicine, Rehabilitation and Disease Prevention, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Karsten Krüger
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Science, Justus-Liebig-University Gießen, Gießen, Germany
| | - Philipp Zimmer
- Division of Performance and Health (Sports Medicine), Institute for Sport and Sport Science, TU Dortmund University, Dortmund, Germany
| | - Thomas Stöggl
- Department of Sport and Exercise Science, University of Salzburg, Schlossallee 49, Salzburg, 5400 Hallein-Rif, Austria.
- Red Bull Athlete Performance Center, Salzburg, Austria.
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5
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Sharma A, Sanchez J, Dew M, Shergill G. Valproate-Associated Transaminitis and Rhabdomyolysis. Cureus 2023; 15:e38348. [PMID: 37261170 PMCID: PMC10229196 DOI: 10.7759/cureus.38348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 06/02/2023] Open
Abstract
Valproic acid (VPA), a common anti-epileptic with prevalent use, has many side effects such as alopecia, abdominal discomfort, thrombocytopenia, etc. Other than those documented, publications cite the drug's rare side effects, such as hepatotoxicity, coagulation disorders, hyperammonemic encephalopathy, rhabdomyolysis, etc. We present the case of a 24-year-old man who was started on valproic acid after a seizure episode and developed mild transaminitis and rhabdomyolysis within 24 hours of drug initiation. Cessation of the drug led to the resolution of raised creatinine kinase and transaminase levels.
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Affiliation(s)
- Anupam Sharma
- Internal Medicine, Crozer-Chester Medical Center, Chester, USA
| | | | - Madison Dew
- Internal Medicine, Drexel College of Medicine, Philadelphia, USA
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6
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Masolitin SV, Magomedov MA, Kim TG, Tyurin IN, Smetanina VM, Kalinin EY, Protsenko DN. Use of Selective Hemosorption and Hemodiafiltration in a Patient with Toxic Rhabdomyolysis Complicated by Acute Kidney Injury. MESSENGER OF ANESTHESIOLOGY AND RESUSCITATION 2022. [DOI: 10.21292/2078-5658-2022-19-6-78-85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
| | - M. A. Magomedov
- N. I. Pirogov City Clinical Hospital no. 1; Pirogov Russian National Research Medical University
| | - T. G. Kim
- N. I. Pirogov City Clinical Hospital no. 1
| | - I. N. Tyurin
- Kommunarka Moscow Multidisciplinary Clinical Center; Pirogov Russian National Research Medical University
| | | | | | - D. N. Protsenko
- Kommunarka Moscow Multidisciplinary Clinical Center; Pirogov Russian National Research Medical University
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7
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Rhabdomyolysis-induced acute kidney injury and concomitant apoptosis induction via ROS-mediated ER stress is efficaciously counteracted by epigallocatechin gallate. J Nutr Biochem 2022; 110:109134. [PMID: 36028100 DOI: 10.1016/j.jnutbio.2022.109134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 01/13/2023]
Abstract
Rhabdomyolysis induced acute kidney injury (RIAKI) is a life-threatening condition responsible for approximately 19-58% of AKI cases worldwide. We performed an intramuscular injection of glycerol (10 mL/kg) in male wistar rats to induce AKI. Epigallocatechin gallate (EGCG) was administered for 3 consecutive days to evaluate its protective effects. We observed significant downregulation in serum creatinine, blood urea nitrogen (BUN) and LDH at different time points on EGCG treatment groups in a dose-dependent manner. Similarly, H&E staining also revealed that EGCG was able to reduce the formation of damaged tubules and tubular necrosis which was prominently spread throughout the kidney tissue of glycerol treatment group. Concomitantly, we observed upregulated inflammation, ER stress and elevated oxidative stress in the glycerol treated group only, which was significantly normalized upon EGCG treatment in both in vitro and in vivo studies. The occurrence of apoptosis in kidney tubules was found to be relatively higher in glycerol treated group and H2O2 treated HEK-293 cells. The results obtained after EGCG treatment revealed a significant decrease in apoptotic cell population, which was further validated by immunofluorescence staining against p53 and comet assay in HEK-293 cells and p53 IHC in kidney tissues. Western blotting also revealed a systemic downregulation of intrinsic mitochondrial apoptotic pathway markers such as bax, bcl-2, pro and cleaved caspase 3, caspase 9 and PARP1. Additionally, the results for flow cytometry analysis and TUNEL assay corroborated apoptotic equilibrium. Conclusively, we reckon EGCG as a multi-therapeutic natural product that can be used the for treatment of AKI.
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8
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Torr L, Mortimore G. The management and diagnosis of rhabdomyolysis-induced acute kidney injury: a case study. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:844-852. [PMID: 36094035 DOI: 10.12968/bjon.2022.31.16.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Rhabdomyolysis is characterised by a rapid dissolution of damaged or injured skeletal muscle that can be the result of a multitude of mechanisms. It can range in severity from mild to severe, leading to multi-organ failure and death. Rhabdomyolysis causes muscular cellular breakdown, which can cause fatal electrolyte imbalances and metabolic acidosis, as myoglobin, creatine phosphokinase, lactate dehydrogenase and other electrolytes move into the circulation; acute kidney injury can follow as a severe complication. This article reflects on the case of a person who was diagnosed with rhabdomyolysis and acute kidney injury after a fall at home. Understanding the underpinning mechanism of rhabdomyolysis and the associated severity of symptoms may improve early diagnosis and treatment initiation.
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Affiliation(s)
- Leah Torr
- Acute Kidney Injury Specialist Nurse, Royal Derby Hospital, University Hospitals of Derby and Burton Foundation Trust, Derby
| | - Gerri Mortimore
- Associate Professor in Advanced Clinical Practice, University of Derby, Derby
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9
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Elkholi IE, Elsherbiny ME, Emara M. Myoglobin: From physiological role to potential implications in cancer. Biochim Biophys Acta Rev Cancer 2022; 1877:188706. [PMID: 35247507 DOI: 10.1016/j.bbcan.2022.188706] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/18/2022] [Accepted: 02/26/2022] [Indexed: 10/19/2022]
Abstract
Myoglobin (MB) belongs to the well-studied globin proteins superfamily. It has been extensively studied for its physiological roles in oxygen storage and transport for about a century now. However, the last two decades shed the light on unexpected aspects for MB research. Myoglobin has been suggested as a scavenger for nitric oxide and reactive oxygen species (ROS). Furthermore, MB was found to be expressed and regulated in different tissues, beyond the muscle lineage, including cancers. Current evidence suggest that MB is directly regulated by hypoxia and might be contributing to the metabolic rewiring in cancer tissues. In this article, we first discuss the MB physiological roles and then focus on the latter potential roles and regulatory networks of MB in cancer.
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Affiliation(s)
- Islam E Elkholi
- Center for Aging and Associated Diseases (CAAD), Zewail City of Science, Technology, and Innovation, 6th of October City, Giza 12578, Egypt; Montreal Clinical Research Institute (IRCM), Montréal, QC H2W 1R7, Canada; Molecular Biology Programs, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Marwa E Elsherbiny
- Department of Pharmacology and Toxicology, Ahram Canadian University, 6th of October City, Giza, Egypt
| | - Marwan Emara
- Center for Aging and Associated Diseases (CAAD), Zewail City of Science, Technology, and Innovation, 6th of October City, Giza 12578, Egypt.
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10
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Wang C, Yu B, Chen R, Su L, Wu M, Liu Z. Association of D-dimer and acute kidney injury associated with rhabdomyolysis in patients with exertional heatstroke: an over 10-year intensive care survey. Ren Fail 2021; 43:1561-1568. [PMID: 34839765 PMCID: PMC8635537 DOI: 10.1080/0886022x.2021.2008975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Patients with rhabdomyolysis (RM) following exertional heatstroke (EHS) are often accompanied by dysfunction of coagulation and acute kidney injury (AKI). The purpose of this study was to investigate the relationship between D-dimer and AKI in patients with RM following EHS. A retrospective study was performed on patients with EHS admitted to the intensive care unit over 10-year. Data including baseline clinical information at admission, vital organ dysfunction, and 90-day mortality were collected. A total of 84 patients were finally included, of whom 41 (48.8%) had AKI. AKI patients had more severe organ injury and higher 90-day mortality (34.1 vs.0.0%, p < 0.001) than non-AKI patients. Multivariate logistic analysis showed that D-dimer (OR 1.3, 95% CI 1.1–1.7, p = 0.018) was an independent risk factor for AKI with RM following EHS. Curve fitting showed a curve relationship between D-dimer and AKI. Two-piecewise linear regression showed that D-dimer was associated with AKI in all populations (OR 1.3, 95% CI 1.2–1.5, p < 0.001) when D-dimer <10.0 mg/L, in RM group (OR 1.3, 95% CI 1.1–1.5, p < 0.001) when D-dimer >0.4 mg/L, in the non-RM group (OR 6.4, 95% CI 1.7–23.9, p = 0.005) when D-dimer <1.3 mg/L and D-dimer did not increase the incidence of AKI in the non-RM group when D-dimer >1.3 mg/L. AKI is a life-threatening complication of RM following EHS. D-dimer is associated with AKI in critically ill patients with EHS. The relationship between D-dimer and AKI depends on whether RM is present or not.
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Affiliation(s)
- Conglin Wang
- Department of Critical Care Medicine, General Hospital of Southern Theatre Command of Peoples Liberation Army, Guangzhou, China
| | - Baojun Yu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Critical Care Medicine, Bao'an People's Hospital, Shenzhen, China
| | - Ronglin Chen
- Department of Critical Care Medicine, General Hospital of Southern Theatre Command of Peoples Liberation Army, Guangzhou, China.,Department of Critical Care Medicine, Central People's Hospital of Longgang, Shenzhen, China
| | - Lei Su
- Department of Critical Care Medicine, General Hospital of Southern Theatre Command of Peoples Liberation Army, Guangzhou, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Key Laboratory of Hot Zone Trauma Care and Tissue Repair of Peoples Liberation Army, General Hospital of Southern Theatre Command of Peoples Liberation Army, Guangzhou, China
| | - Ming Wu
- Department of Critical Care Medicine and Hospital Infection Prevention and Control, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, China
| | - Zhifeng Liu
- Department of Critical Care Medicine, General Hospital of Southern Theatre Command of Peoples Liberation Army, Guangzhou, China.,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Key Laboratory of Hot Zone Trauma Care and Tissue Repair of Peoples Liberation Army, General Hospital of Southern Theatre Command of Peoples Liberation Army, Guangzhou, China
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11
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Wu M, Wang C, Liu Z, Liu Z. Sequential Organ Failure Assessment Score for Prediction of Mortality of Patients With Rhabdomyolysis Following Exertional Heatstroke: A Longitudinal Cohort Study in Southern China. Front Med (Lausanne) 2021; 8:724319. [PMID: 34708052 PMCID: PMC8542709 DOI: 10.3389/fmed.2021.724319] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/07/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Heatstroke is a medical emergency that causes multi-organ injury and death without intervention, but limited data are available on the illness scores in predicting the outcomes of exertional heat stroke (EHS) with rhabdomyolysis (RM). The aim of our study was to investigate the Sequential Organ Failure Assessment (SOFA) score in predicting mortality of patients with RM after EHS. Methods: A retrospective cohort study was performed, which included all patients with EHS admitted into the intensive care unit (ICU) of General Hospital of Southern Theater Command of Peoples Liberation Army from January 2008 to June 2019. RM was defined as creatine kinase (CK) > 1,000 U/L. Data, including the baseline data at admission, vital organ function indicators, and 90-day mortality, were reviewed. Results: A total of 176 patients were enrolled; among them, 85 (48.3%) had RM. Patients with RM had a significantly higher SOFA score (4.0 vs. 3.0, p = 0.021), higher occurrence rates of disseminated intravascular coagulation (DIC) (53.1 vs. 18.3%, p < 0.001) and acute liver injury (ALI) (21.4 vs. 5.5%, p = 0.002) than patients with non-RM. RM was positively correlated with ALI and DIC, and the correlation coefficients were 0.236 and 0.365, respectively (both p-values <0.01). Multivariate logistics analysis showed that the SOFA score [odds ratio (OR) 1.7, 95% CI 1.1-2.6, p = 0.024] was the risk factor for 90-day mortality in patients with RM after EHS, with the area under the curve (AUC) 0.958 (95% CI 0.908-1.000, p < 0.001) and the optimal cutoff 7.5 points. Conclusions: Patients with RM after EHS have severe clinical conditions, which are often accompanied by DIC or ALI. The SOFA score could predict the prognosis of patients with RM with EHS. Early treatment strategies based on decreasing the SOFA score at admission may be pivotal to reduce the 90-day mortality of patients with EHS.
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Affiliation(s)
- Ming Wu
- Department of Critical Care Medicine and Hospital Infection Prevention and Control, Health Science Center, The Second People's Hospital of Shenzhen, First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Department of Critical Care Medicine, General Hospital of Southern Theatre Command of Peoples Liberation Army, Guangzhou, China
| | - Conglin Wang
- Department of Critical Care Medicine, General Hospital of Southern Theatre Command of Peoples Liberation Army, Guangzhou, China
| | - Zheying Liu
- Department of Critical Care Medicine, General Hospital of Southern Theatre Command of Peoples Liberation Army, Guangzhou, China
| | - Zhifeng Liu
- Department of Critical Care Medicine, General Hospital of Southern Theatre Command of Peoples Liberation Army, Guangzhou, China
- Key Laboratory of Hot Zone Trauma Care and Tissue Repair of Peoples Liberation Army, General Hospital of Southern Theatre Command of Peoples Liberation Army, Guangzhou, China
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12
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Abo-Zalam HB, El-Denshary ES, Abdelsalam RM, Khalil IA, Khattab MM, Hamzawy MA. Therapeutic advancement of simvastatin-loaded solid lipid nanoparticles (SV-SLNs) in treatment of hyperlipidemia and attenuating hepatotoxicity, myopathy and apoptosis: Comprehensive study. Biomed Pharmacother 2021; 139:111494. [PMID: 34243595 DOI: 10.1016/j.biopha.2021.111494] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/25/2021] [Accepted: 03/09/2021] [Indexed: 11/28/2022] Open
Abstract
This study set out to optimize simvastatin (SV) in lipid nanoparticles (SLNs) to improve bioavailability, efficacy and alleviate adverse effects. Simvastatin-loaded solid lipid nanoparticles (SV-SLNs) were prepared by hot-melt ultrasonication method and optimized by box-Behnken experimental design. Sixty Wister albino rats were randomly assigned into six groups and treated daily for 16 weeks: control group, the group fed with 20 g of high-fat diet (HFD), group treated with vehicle (20 mg/kg, P.O.) for last four weeks, group treated with HFD and SV (20 mg/kg, P.O.) / or SV-SLNs (20 mg/kg/day, P.O.) / or SV-SLNs (5 mg/kg, P.O.) at last four weeks. Blood, liver tissues, and quadriceps muscles were collected for biochemical analysis, histological and immunohistochemical assays. The optimized SV-SLNS showed a particle-size 255.2 ± 7.7 nm, PDI 0.31 ± 0.09, Zeta-potential - 19.30 ± 3.25, and EE% 89.81 ± 2.1%. HFD showed severe changes in body weight liver functions, lipid profiles, atherogenic index (AIX), albumin, glucose, insulin level, alkaline phosphatase as well as muscle injury, oxidative stress biomarkers, and protein expression of caspase-3. Simvastatin treatment in animals feed with HFD showed a significant improvement of all tested parameters, but it was associated with hepatotoxicity, myopathy, and histological changes in quadriceps muscles. SV-SLNs exhibited a significant improvement of all biochemical, histological examinations, and immunohistochemical assays. SV-SLNs (5 mg/kg) treatment returns all measured parameters to control itself. These results represent that SV-SLNs is a promising candidate as a drug carrier for delivering SV with maximum efficacy and limited adverse reaction.
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Affiliation(s)
- Hagar B Abo-Zalam
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, 6th of October University, 6th of October, Giza, Egypt
| | - Ezzeldein S El-Denshary
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Rania M Abdelsalam
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt; School of Pharmacy, New Giza University, Giza, Egypt
| | - Islam A Khalil
- Department of Pharmaceutics and Industrial Pharmacy, College of Pharmacy and Drug Manufacturing, Misr University of Science and Technology (MUST), 6th of October, Giza 12566, Egypt
| | - Mahmoud M Khattab
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Mohamed A Hamzawy
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Fayoum University, Fayoum, Egypt.
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13
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Yang CW, Li S, Dong Y, Paliwal N, Wang Y. Epidemiology and the Impact of Acute Kidney Injury on Outcomes in Patients with Rhabdomyolysis. J Clin Med 2021; 10:jcm10091950. [PMID: 34062839 PMCID: PMC8125267 DOI: 10.3390/jcm10091950] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Currently, no large, nationwide studies have been conducted to analyze the demographic factors, underlying comorbidities, clinical outcomes, and health care utilization in rhabdomyolysis patients with and without acute kidney injury (AKI). Methods: We queried the National Inpatient Sample of Healthcare Cost and Utilization Project (HCUP) with patients with rhabdomyolysis from 2016 to 2018. The chi-squared test was used to compare categorical variables, and the adjusted Wald test was employed to compare quantitative variables. The logistic regression model was applied to calculate adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) to estimate the impact of AKI on outcomes in patients with rhabdomyolysis. Results: Among 111,085 rhabdomyolysis-related hospitalizations, a higher prevalence of AKI was noticed in older patients (mean age ± SD, 58.2 ± 21.6 vs. 53.8 ± 22.2), Medicare insurance (48.5% vs. 43.2%), and patients with a higher Charlson Comorbidity Index score (CCI 3–5, 15.1% vs. 5.5%). AKI was found to be independently associated with higher mortality (adjusted odds ratio [aOR] 3.33, 95% CI 2.33–4.75), longer hospital stays (adjusted difference 1.17 days, 95% CI: 1.00−1.34), and higher cost of hospital stay (adjusted difference $11,315.05, 95% CI: $9493.02–$13,137.07). Conclusions: AKI in patients hospitalized with rhabdomyolysis is related to adverse clinical outcomes and significant economic and survival burden.
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Affiliation(s)
- Chien-Wen Yang
- Renal Electrolyte and Hypertension Division, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA;
| | - Si Li
- Department of Internal Medicine, Wright Center for Graduate Medical Education, 501 S Washington Ave, Scranton, PA 18505, USA;
- Correspondence:
| | - Yishan Dong
- Department of Internal Medicine, Rochester General Hospital, 1425 Portland Ave, Rochester, NY 14621, USA;
| | - Nitpriya Paliwal
- Department of Internal Medicine, Wright Center for Graduate Medical Education, 501 S Washington Ave, Scranton, PA 18505, USA;
| | - Yichen Wang
- Mercy Internal Medicine Service, Trinity Health of New England, 271 Carew St, Springfield, MA 01104, USA;
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14
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The Potential Role of Exercise-Induced Muscle Damage in Exertional Heat Stroke. Sports Med 2021; 51:863-872. [PMID: 33528800 DOI: 10.1007/s40279-021-01427-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 01/06/2023]
Abstract
Exertional heat stroke (EHS) is a life-threatening condition that affects mainly athletes, military personnel, firefighters, and occupational workers. EHS is frequently observed in non-compensable conditions (where the body is unable to maintain a steady thermal balance) as a result of heavy heat stress and muscle contraction associated with prolonged and strenuous physical and occupational activities, resulting in central nervous system dysfunction followed by multi-organ damage and failure. Since the pathophysiology of EHS is complex and involves multiple organs and systems, any condition that changes the interrelated systems may increase the risk for EHS. It has been suggested that exercise-induced muscle damage (EIMD) can lead to thermoregulatory impairment and systemic inflammation, which could be a potential predisposing factor for EHS. In this review article, we aim to (1) address the evidence of EIMD as a predisposing factor for EHS and (2) propose a possible mechanism of how performing muscle-damaging exercise in the heat may aggravate muscle damage and subsequent risk of EHS and acute kidney injury (AKI). Such an understanding could be meaningful to minimize the risks of EHS and AKI for individuals with muscle damage due to engaging in physical work in hot environments.
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15
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Scharf C, Liebchen U, Paal M, Irlbeck M, Zoller M, Schroeder I. Blood purification with a cytokine adsorber for the elimination of myoglobin in critically ill patients with severe rhabdomyolysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:41. [PMID: 33509234 PMCID: PMC7844984 DOI: 10.1186/s13054-021-03468-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/13/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Rhabdomyolysis is frequently occurring in critically ill patients, resulting in a high risk of acute kidney injury (AKI) and potentially permanent kidney damage due to increased myoglobin levels. The extracorporeal elimination of myoglobin might be an approach to prevent AKI, but its molecular weight of 17 kDa complicates an elimination with conventional dialysis membranes. Question of interest is, if myoglobin can be successfully eliminated with the cytokine adsorber Cytosorb® (CS) integrated in a high-flux dialysis system. METHODS Patients were included between 10/2014 and 05/2020 in the study population if they had an anuric renal failure with the need of renal replacement therapy, if CS therapy was longer than 90 min and if myoglobin level was > 5.000 ng/ml before treatment. The measurement times of the laboratory values were: d-1 = 24-36 h before CS, d0 = shortly before starting CS and d1 = 12-24 h after starting CS treatment. Statistical analysis were performed with Spearman's correlation coefficient, Wilcoxon test with associated samples and linear regression analysis. RESULTS Forty-three patients were included in the evaluation (median age: 56 years, 77% male patients, 32.6% ECMO therapy, median SAPS II: 80 points and in-hospital mortality: 67%). There was a significant equilateral correlation between creatine kinase (CK) and myoglobin at all measurement points. Furthermore, there was a significant reduction of myoglobin (p = 0.03, 95% confidence interval (CI): - 9030, - 908 ng/ml) during CS treatment, with a median relative reduction of 29%. A higher median reduction of 38% was seen in patients without ongoing rhabdomyolysis (CK decreased during CS treatment, n = 21). In contrast, myoglobin levels did not relevantly change in patients with increasing CK and therefore ongoing rhabdomyolysis (n = 22, median relative reduction 4%). Moreover, there was no significant difference in myoglobin elimination in patients with and without ECMO therapy. CONCLUSION Blood purification with Cytosorb® during high-flux dialysis led to a significant reduction of myoglobin in patients with severe rhabdomyolysis. The effect might be obscured by sustained rhabdomyolysis, which was seen in patients with rising CK during treatment. Prospective clinical trials would be useful in investigating its benefits in avoiding permanent kidney damage.
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Affiliation(s)
- Christina Scharf
- Department of Anesthesiology, LMU Hospital, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Uwe Liebchen
- Department of Anesthesiology, LMU Hospital, Marchioninistrasse 15, 81377, Munich, Germany
| | - Michael Paal
- Institute of Laboratory Medicine, LMU Hospital, Munich, Germany
| | - Michael Irlbeck
- Department of Anesthesiology, LMU Hospital, Marchioninistrasse 15, 81377, Munich, Germany
| | - Michael Zoller
- Department of Anesthesiology, LMU Hospital, Marchioninistrasse 15, 81377, Munich, Germany
| | - Ines Schroeder
- Department of Anesthesiology, LMU Hospital, Marchioninistrasse 15, 81377, Munich, Germany
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16
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Rauch S, Borgato A, Gruber E, Leggieri C, Bock M, Seraglio PME. Case Report: Prevention of Rhabdomyolysis-Associated Acute Kidney Injury by Extracorporeal Blood Purification With Cytosorb ®. Front Pediatr 2021; 9:801807. [PMID: 35141180 PMCID: PMC8819180 DOI: 10.3389/fped.2021.801807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/29/2021] [Indexed: 01/06/2023] Open
Abstract
Acute kidney injury (AKI) is a severe complication of rhabdomyolysis. The pathophysiology of rhabdomyolysis-associated AKI is complex, but myoglobin related damage plays a major role. Extracorporeal removal of myoglobin is therefore an appealing target to prevent AKI, however, attempts to remove myoglobin with standard dialysis membranes have so far been disappointing. Here we report the case of a 12-year-old boy with severe trauma-related rhabdomyolysis where we successfully utilized continuous renal replacement therapy in combination with Cytosorb® to eliminate myoglobin and prevent AKI. The early use of extracorporeal myoglobin removal with Cytosorb® after severe rhabdomyolysis might be an option and should be further investigated as a tool to prevent the development of AKI.
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Affiliation(s)
- Simon Rauch
- Department of Anesthesia and Intensive Care Medicine, "F. Tappeiner" Hospital, Merano, Italy.,Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Andrea Borgato
- Department of Anesthesia and Intensive Care Medicine, "F. Tappeiner" Hospital, Merano, Italy
| | - Ewald Gruber
- Department of Surgery, "F. Tappeiner" Hospital, Merano, Italy
| | - Carlo Leggieri
- Department of Anesthesia and Intensive Care Medicine, "F. Tappeiner" Hospital, Merano, Italy
| | - Matthias Bock
- Department of Anesthesia and Intensive Care Medicine, "F. Tappeiner" Hospital, Merano, Italy.,Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
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17
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Jheong JH, Hong SK, Kim TH. Acute Kidney Injury After Trauma: Risk Factors and Clinical Outcomes. JOURNAL OF ACUTE CARE SURGERY 2020. [DOI: 10.17479/jacs.2020.10.3.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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18
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Hayashida R, Tsuchiya K, Nakamura S, Harima N, Ichijo M, Furuya F, Kitamura K. Acute Kidney Injury with Hemolysis after Glycerin Enema-induced Rectal Injury in a Patient with Type 2 Diabetes. Intern Med 2020; 59:1659-1663. [PMID: 32269190 PMCID: PMC7402962 DOI: 10.2169/internalmedicine.4217-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
A 66-year-old man with type 2 diabetes was admitted for glycemic control and weight loss. The rectal mucosa was unfortunately injured during glycerin enema administration in preparation for colonoscopy, after which dark red urine and renal dysfunction were observed. Considering the clinical diagnosis of glycerol-induced hemolysis and acute kidney injury, intravenous hydration and haptoglobin administration were started, which successfully treated the dark red urine and renal dysfunction. This case highlights the importance of appropriate glycerin enema administration and emphasizes the need to recognize glycerol-induced hemolysis and acute kidney injury as complications of glycerin enemas. This case also provides insight into glycerol-induced hemolysis and acute kidney injury as complications of glycerin enemas.
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Affiliation(s)
- Ryosuke Hayashida
- Third Department of Internal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Japan
| | - Kyoichiro Tsuchiya
- Third Department of Internal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Japan
| | - Suguru Nakamura
- Third Department of Internal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Japan
| | - Noriyuki Harima
- Third Department of Internal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Japan
| | - Masashi Ichijo
- Third Department of Internal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Japan
| | - Fumihiko Furuya
- Third Department of Internal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Japan
| | - Kenichiro Kitamura
- Third Department of Internal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Japan
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19
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Butragueño Laiseca L, Estepa Pedregosa L, Sánchez Galindo AC, Santiago Lozano MJ. Hemolysis and methemoglobinemia in a child with left ventricular assist Levitronix PediMag. Int J Artif Organs 2020; 44:68-71. [PMID: 32552341 DOI: 10.1177/0391398820932175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 5-month-old male was treated with left ventricular assist device due to cardiac failure secondary to dilated cardiomyopathy. The patient developed acute severe intravascular hemolysis with methemoglobinemia and renal failure, related to a mechanical problem due to pump cylinder misalignment. Secondary severe methemoglobinemia has not been previously described in patients undergoing ventricular assist device. Early detection of the signs and symptoms of hemolysis is crucial to prevent further complications.
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Affiliation(s)
- Laura Butragueño Laiseca
- Department of Pediatric Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain
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20
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Daum HC, Schmidt BMW, Napp LC. Effects of Hemoadsorption with CytoSorb during Severe Rhabdomyolysis. Blood Purif 2020; 50:268-269. [PMID: 32535606 DOI: 10.1159/000508277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/28/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Hannah C Daum
- Cardiac Arrest Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Bernhard M W Schmidt
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Lars Christian Napp
- Cardiac Arrest Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany,
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21
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Weng C, Lan K, Li T, Zhang L, Wang J, Lai X. Regional hypothermia attenuates secondary-injury caused by time-out application of tourniquets following limb fragments injury combined with hemorrhagic shock. Scand J Trauma Resusc Emerg Med 2019; 27:104. [PMID: 31752982 PMCID: PMC6873525 DOI: 10.1186/s13049-019-0678-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 10/10/2019] [Indexed: 01/04/2023] Open
Abstract
Background Tourniquet is the most widely used and effective first-aid equipment for controlling hemorrhage of injured limb in battlefield. However, time-out application of tourniquets leads to ischemic-necrosis of skeletal muscles and ischemia-reperfusion injury. Regional hypothermia (RH) on wounded limb can relieve the injury on local tissue and distant organs. We aimed to investigate the protective effects of RH on rabbits’ limbs injured by a steel-ball combined with hemorrhagic-shock, and then employed tourniquet over-time, tried to identify the optimal treatment RH. Methods Thirty rabbits were randomly divided into 5 groups. All rabbits were anesthetized, intubated femoral artery and vein in right-hind limbs. Sham operation group (Sham): only femoral arteriovenous cannula in right-hind limb. None RH group (NRH): rabbits were intubated as Sham group, then the soft tissues of rabbits’ left-hinds were injured by a steel-ball shooting, and were exsanguinated until shock, then bundled with rubber tourniquets for 4 h. Three RH subgroups: rabbits were injured as mentioned above, the injured limbs were bundled with rubber tourniquets and treated with different temperature (5 ± 1 °C, 10 ± 1 °C, and 20 ± 1 °C, respectively) for 4 h. The injury severity of lung and regional muscle was assessed by histologic examination. Activity of adenosine triphosphatase (ATPase) and content of malondialdehyde (MDA) in muscle, inflammatory cytokines, myoglobin, creatine kinase-MM (CK-MM), Heme, Heme oxygenase 1 (HO-1), lactic acid (Lac), and lectrolyte ion in serum were detected. Results Following with RH treatment, the injury of lung and local muscle tissue was alleviated evidencing by mitigation of histopathological changes, significant decrease of water-content and MDA content, and increase of ATPase activity. Lower level of Lac, Potassium (K+), inflammatory cytokines, Heme, CK-MM, myoglobin content, and higher level of Calcium (Ca2+), HO-1 content were shown in RH treatment. 10 °C was the most effective RH to increase ATPase activity, and decrease MDA, myoglobin, CK-MM content. Conclusion Transient RH (4 h) had a “long-term mitigation effects” (continued for 6 h) on time-out application of tourniquet with the fluid resuscitation and core temperature maintenance, and the most effective temperature for reducing the side effects on tourniquet time-out application was 10 °C.
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Affiliation(s)
- Changmei Weng
- Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, 400042, China.,State Key Laboratory of Trauma, Burn and Combined Injury Research Institute, Third Military Medical University, Chongqing, 400042, China
| | - Kai Lan
- State Key Laboratory of Trauma and Burns, Surgery Research Institute; Research Institute of Surgery, Daping Hospital, Third Military Medical University, 10 Changjiang Road, Chongqing, 400042, China
| | - Tao Li
- Joint Surgery Center, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Liangchao Zhang
- Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, 400042, China.,State Key Laboratory of Trauma, Burn and Combined Injury Research Institute, Third Military Medical University, Chongqing, 400042, China
| | - Jianmin Wang
- Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, 400042, China.,State Key Laboratory of Trauma, Burn and Combined Injury Research Institute, Third Military Medical University, Chongqing, 400042, China
| | - Xinan Lai
- Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, 400042, China. .,State Key Laboratory of Trauma, Burn and Combined Injury Research Institute, Third Military Medical University, Chongqing, 400042, China.
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22
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Sekulic M, Waikar S, Motwani SS, Weins A, Rennke HG. Chromogranin A Tubulopathy: Differing Histopathologic Patterns of Acute Tubular Injury in the Setting of Neuroendocrine Neoplasms. Kidney Int Rep 2019; 4:1085-1093. [PMID: 31440699 PMCID: PMC6698283 DOI: 10.1016/j.ekir.2019.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/29/2019] [Indexed: 02/01/2023] Open
Abstract
Introduction Neoplasms of neuroendocrine derivation or differentiation may express specific peptides, some of which are capable of producing clinical symptomatology and others used as biomarkers: one such peptide being chromogranin A (CGA). Herein, we describe histopathologic changes present in kidney specimens from patients with such neoplasms, and illustrate 2 patterns of acute tubular injury (ATI) attributable to CGA. Methods Eleven patients with a history of a neoplasm of neuroendocrine derivation or differentiation and having histopathologic sampling of the kidney were retrospectively identified, 3 of whom had ATI with either engorgement of the proximal tubular epithelium by resorbed material or tubular cast formation. Results Two patterns of ATI were observed. One characterized by acutely injured proximal tubular cells engorged with resorption granules that expressed CGA via immunoperoxidase staining. Another pattern was characterized by intraluminal tubular cast material associated with ATI that did not exhibit restriction of immunoglobulin light chains (LCs), but immunoperoxidase staining for CGA revealed that the cast material was composed of the neuroendocrine-associated peptide. The level of serum CGA does not appear to necessarily equate to developing either of these 2 patterns of ATI. Conclusions Patients with a neoplasm of neuroendocrine derivation or differentiation may develop ATI, and in certain cases may be secondary to CGA renal tubular deposition.
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Affiliation(s)
- Miroslav Sekulic
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sushrut Waikar
- Division of Nephrology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Shveta S Motwani
- Division of Nephrology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Astrid Weins
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Helmut G Rennke
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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23
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Napp LC, Ziegeler S, Kindgen-Milles D. Rationale of Hemoadsorption during Extracorporeal Membrane Oxygenation Support. Blood Purif 2019; 48:203-214. [PMID: 31096211 PMCID: PMC6878728 DOI: 10.1159/000500015] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/29/2019] [Indexed: 12/14/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support are increasingly used for treating various forms of shock, lung failure, protected interventions and life support including resuscitation. Most patients on ECMO are affected by a systemic inflammatory response caused by the underlying disease as well as the ECMO support itself, which contributes to vasoplegia, multi-organ failure, deterioration and death. Unfortunately, effective strategies for control of inflammation and related organ failure and shock on ECMO are lacking. Recently, a new polystyrene-based device for hemoadsorption, which aims to reduce excessive levels of inflammatory molecules such as interleukins, cytokines as well as damage- and pathogen-associated molecular patterns, has become available. Here we summarize the rationale, available data and technical aspects of polystyrene-based hemoadsorption during ECMO support, and give recommendations based on existing experience.
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Affiliation(s)
- L Christian Napp
- Department of Cardiology and Angiology, Cardiac Arrest Center, Advanced Heart Failure Unit, Hannover Medical School, Hannover, Germany,
| | - Stephan Ziegeler
- Department of Anesthesiology, Operative Intensive Care Medicine, Pain Management and Emergency Medicine, Hospital Ibbenbüren, Ibbenbüren, Germany
| | - Detlef Kindgen-Milles
- Department of Anesthesiology, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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24
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Protocols for documentation of electrical injuries for electrical safety inspectors and emergency medical practitioners. J Trauma Acute Care Surg 2019; 87:483-490. [PMID: 31045725 DOI: 10.1097/ta.0000000000002346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Electric shocks are common, and victims report difficulty in finding practitioners with knowledge of the injury. Medical Practitioners, especially in private practice, report lack of knowledge of the injury and lack of expertise in assessing and treating the injury. The authors are often requested to suggest investigation protocols, assessment protocols, and treatment protocols, and to provide educational information. METHODS The international body establishing electrical standards on the effects of current on the body (International Electrotechnical Commission, Maintenance Team 4 (MT4) of Technical Committee 64 (TC64)) have established protocols for the factors which require documentation and reporting of the injury. This article provides a narrative approach to using these protocols in accord with the standards (IEC 60479). The level of evidence is Level III (US/Canada classification). TYPE: This article collects together and collates physical and medical aspects of investigating electric shocks, and summarizes those of importance, and which are potentially forgotten. The thoroughness of initial assessment is emphasized. SUBSTANCE Summaries are set out to guide first attenders and emergency medical personnel as to findings and observations which must be recorded for later comprehensive medicolegal reporting and which are often overlooked. CONCLUSION Wider teaching in the nature of electric shocks will enhance assessment of victims and thorough recording of pertinent information and thus will enhance later medicolegal reporting. Many such factors are initially overlooked and lead to inadequate reporting for forensic purposes.
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25
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Glaser J, Zeman J, Noble S, Fernandez N. CAVH in the Combat Environment: A Case Report and Lessons Learned in Southern Afghanistan. Mil Med 2019; 183:e167-e171. [PMID: 29401336 DOI: 10.1093/milmed/usx017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 10/20/2017] [Indexed: 11/15/2022] Open
Abstract
Background Acute kidney injury is a common complication of both civilian and military trauma. The lack of dedicated resources restrict dialysis in the forward setting. We report a case of a combat polytrauma and renal failure, using continuous arteriovenous hemofiltration to clear uremia and remove volume, allowing for ventilator liberation and safe disposition. Materials and Methods The patient presented with traumatic lower extremity injuries and abdominal wounds and developed acute post-traumatic renal failure. Using available supplies, the patient was cannulated for continuous arteriovenous hemofiltration. Aggressive fluid and electrolyte management accomplished specific goals of ventilator liberation and clearance of uremia. Results Over 48 h, blood urea nitrogen was reduced from 101 mg/dL to 63 mg/dL. Creatinine was reduced from 8.2 mg/dL to 4.7 mg/dL. Acute respiratory distress syndrome was improved reducing P:F (PaO2:FiO2) ratio from 142 to 210. The patient was extubated and transferred safely. Conclusions The ability to perform acute dialysis can be lifesaving. Although resource constrained, we created a dialysis system in the forward environment with a filter and universally available equipment. This represents the first described use of continuous arteriovenous hemofiltration at the NATO Role 3 hospital in Afghanistan. This technique represents another potential tool for deployed trauma teams to improve care.
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Affiliation(s)
- Jacob Glaser
- Naval Medical Research Unit San Antonio, Combat Casualty Care Directorate, 3650 Chambers Pass JBSA Fort Sam Houston, San Antonio, TX 78234
| | - Joseph Zeman
- Department of Pulmonary Critical Care, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889
| | - Stephen Noble
- Department of Cardiothoracic Surgery, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708
| | - Nathanial Fernandez
- Department of Vascular Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134
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Ahmad A, Zain MA, Ashfaq AA, Ullah W. A Late Presentation of Substance-related Rhabdomyolysis with Normal Serum Creatine Kinase Levels and Complicated with Acute Tubular Necrosis. Cureus 2019; 11:e4197. [PMID: 31106097 PMCID: PMC6504020 DOI: 10.7759/cureus.4197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Substance abusers are at increased risk of acute kidney injury (AKI) compared to the general population due to nontraumatic rhabdomyolysis. The primary target of these nephrotoxic agents is the tubulointerstitial compartment and the most frequent findings on biopsy are consistent with acute tubular necrosis (ATN) and acute interstitial nephritis. We present a rare case of an intravenous cocaine and heroin abuser who presented with recent onset oliguria, hematuria, and reduced peroral intake. The urine dipstick testing showed guaiac positivity but no red blood cells on microscopy. The blood workup showed elevated serum creatinine and urea levels but normal creatinine kinase (CK) level. Renal biopsy showed tubular epithelial cell necrosis and positive immunoperoxidase staining for myoglobin pigment casts in renal tubules. The diagnosis of rhabdomyolysis-associated ATN secondary to substance abuse was suggested. However, normal serum CK levels as well as urine drug panel supported the delayed presentation of rhabdomyolysis complicated with ATN. The patient returned to normal health with no residual kidney dysfunction after undergoing temporary hemofiltration.
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Affiliation(s)
- Asrar Ahmad
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, USA
| | - Muhammad A Zain
- Internal Medicine, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, PAK
| | - Ammar A Ashfaq
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, USA
| | - Waqas Ullah
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, USA
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Long B, Koyfman A, Gottlieb M. An evidence-based narrative review of the emergency department evaluation and management of rhabdomyolysis. Am J Emerg Med 2019; 37:518-523. [DOI: 10.1016/j.ajem.2018.12.061] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/20/2018] [Accepted: 12/31/2018] [Indexed: 12/13/2022] Open
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Rouillon J, Lefebvre T, Denard J, Puy V, Daher R, Ausseil J, Zocevic A, Fogel P, Peoc'h K, Wong B, Servais L, Voit T, Puy H, Karim Z, Svinartchouk F. High urinary ferritin reflects myoglobin iron evacuation in DMD patients. Neuromuscul Disord 2018; 28:564-571. [PMID: 29776718 DOI: 10.1016/j.nmd.2018.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 12/26/2017] [Accepted: 03/14/2018] [Indexed: 12/15/2022]
Abstract
Duchenne muscular dystrophy (DMD) is an X-linked disease caused by mutations in the dystrophin gene leading to the absence of the normal dystrophin protein. The efforts of many laboratories brought new treatments of DMD to the reality, but ongoing and forthcoming clinical trials suffer from absence of valuable biomarkers permitting to follow the outcome of the treatment day by day and to adjust the treatment if needed. In the present study the levels of 128 urinary proteins including growth factors, cytokines and chemokines were compared in urine of DMD patients and age related control subjects by antibody array approach. Surprisingly, statistically significant difference was observed only for urinary ferritin whose level was 50 times higher in young DMD patients. To explain the observed high urinary ferritin content we analysed the levels of iron, iron containing proteins and proteins involved in regulation of iron metabolism in serum and urine of DMD patients and their age-matched healthy controls. Obtained data strongly suggest that elevated level of urinary ferritin is functionally linked to the renal management of myoglobin iron derived from leaky muscles of DMD patients. This first observation of the high level of ferritin in urine of DMD patients permits to consider this protein as a new urinary biomarker in muscular dystrophies and sheds light on the mechanisms of iron metabolism and kidney functioning in DMD.
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Affiliation(s)
| | - Thibaud Lefebvre
- INSERM U1149 CNRS ERL 8252, Centre de Recherche sur l'inflammation, Université Paris Diderot, site Bichat, Sorbonne Paris Cité, France, 16 rue Henri Huchard, 75018 Paris, France; Laboratory of excellence, GR-Ex, Paris, France
| | | | - Vincent Puy
- Unité INSERM U1088, CURS-Université de Picardie Jules Verne, Amiens, France; Laboratoire de Biochimie, CHU Amiens, F-80054 Amiens, France
| | - Raed Daher
- INSERM U1149 CNRS ERL 8252, Centre de Recherche sur l'inflammation, Université Paris Diderot, site Bichat, Sorbonne Paris Cité, France, 16 rue Henri Huchard, 75018 Paris, France; Laboratory of excellence, GR-Ex, Paris, France
| | - Jérôme Ausseil
- Unité INSERM U1088, CURS-Université de Picardie Jules Verne, Amiens, France; Laboratoire de Biochimie, CHU Amiens, F-80054 Amiens, France
| | | | | | - Katell Peoc'h
- INSERM U1149 CNRS ERL 8252, Centre de Recherche sur l'inflammation, Université Paris Diderot, site Bichat, Sorbonne Paris Cité, France, 16 rue Henri Huchard, 75018 Paris, France
| | - Brenda Wong
- Division of Pediatric Neurology, Cincinnati Children's Hospital Medical Center, USA
| | - Laurent Servais
- Service of Clinical Trials and Databases, Institut de Myologie, Paris, France
| | - Thomas Voit
- University College London, NIHR Biomedical Research Centre, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Herve Puy
- INSERM U1149 CNRS ERL 8252, Centre de Recherche sur l'inflammation, Université Paris Diderot, site Bichat, Sorbonne Paris Cité, France, 16 rue Henri Huchard, 75018 Paris, France; Laboratory of excellence, GR-Ex, Paris, France
| | - Zoubida Karim
- INSERM U1149 CNRS ERL 8252, Centre de Recherche sur l'inflammation, Université Paris Diderot, site Bichat, Sorbonne Paris Cité, France, 16 rue Henri Huchard, 75018 Paris, France; Laboratory of excellence, GR-Ex, Paris, France
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Low-Dose Sodium Nitrite Fluid Resuscitation Prevents Lethality From Crush Syndrome by Improving Nitric Oxide Consumption and Preventing Myoglobin Cytotoxicity in Kidney in A Rat Model. Shock 2018; 48:112-118. [PMID: 27941593 DOI: 10.1097/shk.0000000000000817] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Crush syndrome (CS) is a serious medical condition characterized by muscle cell damage resulting from pressure. CS has a high mortality, even when patients receive fluid therapy. We examined whether administration of NaNO2-containing fluid can improve survival in a rat model of CS. DESIGN The CS model was generated by subjecting anesthetized rats to bilateral hind limb compression with a rubber tourniquet for 5 h. Rats were then randomly divided into six groups: sham; CS with no treatment; CS with normal saline treatment; CS with normal saline + 25 mEq/L bicarbonate treatment; and CS with normal saline + 200 or 500 μmol/kg NaNO2. MEASUREMENTS AND MAIN RESULTS Blood and tissue samples were collected for histological and biochemical analyses at predetermined time points before and after reperfusion. Ischemic compression of rat hind limbs reduced nitrite content in the crushed muscle, and subsequent reperfusion resulted in reactive oxygen species-induced circulatory dysfunction and systemic inflammation. Rats treated with 200 μmol/kg NaNO2 showed increased nitric oxide (NO) levels, blood circulation, and neoangiogenesis, decreased generation of reactive oxygen species, and suppression of the inflammatory response, leading to complete recovery. CONCLUSIONS Treatment with 200 μmol/kg NaNO2 prevents muscle damage induced by ischemia reperfusion via the protective effects of NO and suppression of systemic inflammation, thereby increasing survival rates in CS.
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Administration of FTY720 during Tourniquet-Induced Limb Ischemia Reperfusion Injury Attenuates Systemic Inflammation. Mediators Inflamm 2017; 2017:4594035. [PMID: 29410598 PMCID: PMC5749296 DOI: 10.1155/2017/4594035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 09/01/2017] [Accepted: 09/12/2017] [Indexed: 12/14/2022] Open
Abstract
Acute ischemia-reperfusion injury (IRI) of the extremities leads to local and systemic inflammatory changes which can hinder limb function and can be life threatening. This study examined whether the administration of the T-cell sequestration agent, FTY720, following hind limb tourniquet-induced skeletal muscle IRI in a rat model would attenuate systemic inflammation and multiple end organ injury. Sprague-Dawley rats were subjected to 1 hr of ischemia via application of a rubber band tourniquet. Animals were randomized to receive an intravenous bolus of either vehicle control or FTY720 15 min after band placement. Rats (n = 10/time point) were euthanized at 6, 24, and 72 hr post-IRI. Peripheral blood as well as lung, liver, kidney, and ischemic muscle tissue was analyzed and compared between groups. FTY720 treatment markedly decreased the number of peripheral blood T cells (p < 0.05) resulting in a decreased systemic inflammatory response and lower serum creatinine levels and had a modest but significant effect in decreasing the transcription of injury-associated target genes in multiple end organs. These findings suggest that early intervention with FTY720 may benefit the treatment of IRI of the limb. Further preclinical studies are necessary to characterize the short-term and long-term beneficial effects of FTY720 following tourniquet-induced IRI.
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Murata I, Abe Y, Yaginuma Y, Yodo K, Kamakari Y, Miyazaki Y, Baba D, Shinoda Y, Iwasaki T, Takahashi K, Kobayashi J, Inoue Y, Kanamoto I. Astragaloside-IV prevents acute kidney injury and inflammation by normalizing muscular mitochondrial function associated with a nitric oxide protective mechanism in crush syndrome rats. Ann Intensive Care 2017; 7:90. [PMID: 28871521 PMCID: PMC5583140 DOI: 10.1186/s13613-017-0313-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/19/2017] [Indexed: 11/26/2022] Open
Abstract
Background Crush syndrome (CS) is a serious medical condition characterized by muscle cell damage resulting from decompression after compression (i.e., ischemia/reperfusion injury). A large number of CS patients develop cardiac failure, kidney dysfunction, and systemic inflammation, even when fluid therapy is administered. We evaluated whether the administration of astragaloside-IV (AS)-containing fluid improved survival by preventing kidney and muscular mitochondrial dysfunction in a rat model of CS. Results The CS model was generated by subjecting anesthetized rats to bilateral hind limb compression with a rubber tourniquet for 5 h. Rats were then randomly divided into four groups: (1) sham; (2) CS with no treatment; (3) CS with normal saline treatment; and (4) CS with normal saline + 10 mg/kg AS. AS-containing fluid improved kidney function by improving shock and metabolic acidosis in CS rats. In addition, there was a reduction in oxidative damage. The attenuation of hyperkalemia was significantly related to improving muscle injury via preventing mitochondrial dysfunction. Moreover, this mitochondria protection mechanism was related to the nitric oxide (NO) generated by activation of endothelial nitric oxide synthase, which provided an anti-oxidative and anti-inflammatory effect. Conclusions Treatment with AS-containing fluid led to a dramatic improvement in survival following CS because of direct and indirect anti-oxidative effects in the kidney, and improvements in mitochondrial dysfunction and inflammation owing to AS acting as an NO donor in injured muscle. Electronic supplementary material The online version of this article (doi:10.1186/s13613-017-0313-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Isamu Murata
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan.
| | - Yuji Abe
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Yuka Yaginuma
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Kayako Yodo
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Yuka Kamakari
- Water and Food Inspection Group, Saitama Prefectural Institute of Public Health, Saitama, Japan
| | - Yurika Miyazaki
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Daichi Baba
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Yuko Shinoda
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Toru Iwasaki
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Kunihiko Takahashi
- Hygiene Inspection Section, Koshigaya City Public Health Center, Saitama, Japan
| | - Jun Kobayashi
- Division of Pathophysiology, Department of Clinical Dietetics and Human Nutrition, Faculty of Pharmaceutical Science, Josai University, Saitama, Japan
| | - Yutaka Inoue
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Ikuo Kanamoto
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
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Moggio A, Geraci S, Boido A, Sticht C, Gretz N, Bussolati B. Assessment of acute kidney injury in rhabdomyolytic mice by transcutaneous measurement of sinistrin excretion. Nephrol Dial Transplant 2017; 32:1167-1175. [DOI: 10.1093/ndt/gfw438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Reeder BJ. Redox and Peroxidase Activities of the Hemoglobin Superfamily: Relevance to Health and Disease. Antioxid Redox Signal 2017; 26:763-776. [PMID: 27637274 DOI: 10.1089/ars.2016.6803] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
SIGNIFICANCE Erythrocyte hemoglobin (Hb) and myocyte myoglobin, although primarily oxygen-carrying proteins, have the capacity to do redox chemistry. Such redox activity in the wider family of globins now appears to have important associations with the mechanisms of cell stress response. In turn, an understanding of such mechanisms in vivo may have a potential in the understanding of cancer therapy resistance and neurodegenerative disorders such as Alzheimer's. Recent Advances: There has been an enhanced understanding of the redox chemistry of the globin superfamily in recent years, leading to advances in development of Hb-based blood substitutes and in hypotheses relating to specific disease mechanisms. Neuroglobin (Ngb) and cytoglobin (Cygb) have been linked to cell protection mechanisms against hypoxia and oxidative stress, with implications in the onset and progression of neurodegenerative diseases for Ngb and cancer for Cygb. CRITICAL ISSUES Despite advances in the understanding of redox chemistry of globins, the physiological roles of many of these proteins still remain ambiguous at best. Confusion over potential physiological roles may relate to multifunctional roles for globins, which may be modulated by surface-exposed cysteine pairs in some globins. Such roles may be critical in deciphering the relationships of these globins in human diseases. FUTURE DIRECTIONS Further studies are required to connect the considerable knowledge on the mechanisms of globin redox chemistry in vitro with the physiological and pathological roles of globins in vivo. In doing so, new therapies for neurodegenerative disorders and cancer therapy resistance may be targeted. Antioxid. Redox Signal. 26, 763-776.
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Affiliation(s)
- Brandon J Reeder
- School of Biological Sciences, University of Essex , Essex, United Kingdom
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Risperidone-Associated Rhabdomyolysis Without Neuroleptic Malignant Syndrome: A Case Report. J Clin Psychopharmacol 2017; 37:105-106. [PMID: 27861195 DOI: 10.1097/jcp.0000000000000614] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nara A, Yajima D, Nagasawa S, Abe H, Hoshioka Y, Iwase H. Evaluations of lipid peroxidation and inflammation in short-term glycerol-induced acute kidney injury in rats. Clin Exp Pharmacol Physiol 2016; 43:1080-1086. [DOI: 10.1111/1440-1681.12633] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 08/07/2016] [Accepted: 08/12/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Akina Nara
- Department of Legal Medicine; Graduate School of Medicine; Chiba University; Chiba Japan
- Department of Forensic Medicine; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Daisuke Yajima
- Department of Legal Medicine; Graduate School of Medicine; Chiba University; Chiba Japan
| | - Sayaka Nagasawa
- Department of Legal Medicine; Graduate School of Medicine; Chiba University; Chiba Japan
| | - Hiroko Abe
- Department of Legal Medicine; Graduate School of Medicine; Chiba University; Chiba Japan
| | - Yumi Hoshioka
- Department of Legal Medicine; Graduate School of Medicine; Chiba University; Chiba Japan
| | - Hirotaro Iwase
- Department of Legal Medicine; Graduate School of Medicine; Chiba University; Chiba Japan
- Department of Forensic Medicine; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
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Onody P, Aranyi P, Turoczi Z, Stangl R, Fulop A, Dudas E, Lotz G, Szijarto A. Levosimendan Administration in Limb Ischemia: Multicomponent Signaling Serving Kidney Protection. PLoS One 2016; 11:e0163675. [PMID: 27684548 PMCID: PMC5042425 DOI: 10.1371/journal.pone.0163675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/11/2016] [Indexed: 11/19/2022] Open
Abstract
Aims and Objectives Acute renal failure is a severe complication of lower extremity major arterial reconstructions, which could even be fatal. Levosimendan is a dual-acting positive inotropic and vasodilatory agent, which is suspected to have protective effects against cardiac ischemia. However, there is no data available on lower limb or remote organ ischemic injuries therefore the aim of the study was to investigate the effect of levosimendan on lower limb ischemia-reperfusion injury and the corollary renal dysfunction. Methods Male Wistar rats underwent 180 min bilateral lower limb ischemia followed by 4 or 24 hours of reperfusion. Intravenous Levosimendan was administered continuously (0.2μg/bwkg/min) throughout the whole course of ischemia and the first 3h of reperfusion. Results were compared with sham-operated and ischemia-reperfusion groups. Hemodynamic monitoring was performed by invasive arterial blood pressure measurement. Kidney and lower limb muscle microcirculation was registered by a laser Doppler flowmeter. After 4h and 24h of reperfusion, serum, urine and histological samples were collected. Results Systemic hemodynamic parameters and microcirculation of kidney and the lower limb significantly improved in the Levosimendan treated group. Muscle viability was significantly preserved 4 and 24 hours after reperfusion. At the same time, renal functional laboratory tests and kidney histology demonstrated significantly less expressive kidney injury in Levosimendan groups. TNF-α levels were significantly less elevated in the Levosimendan group 4 hours after reperfusion. Conclusion The results claim a protective role for Levosimendan administration during major vascular surgeries to prevent renal complications.
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Affiliation(s)
- Peter Onody
- 1 Department of Surgery, Semmelweis University, Budapest, Hungary
| | - Peter Aranyi
- 1 Department of Surgery, Semmelweis University, Budapest, Hungary
| | - Zsolt Turoczi
- 2 Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Rita Stangl
- 1 Department of Surgery, Semmelweis University, Budapest, Hungary
| | - Andras Fulop
- 1 Department of Surgery, Semmelweis University, Budapest, Hungary
| | - Emese Dudas
- 1 Department of Surgery, Semmelweis University, Budapest, Hungary
| | - Gabor Lotz
- 2 Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Attila Szijarto
- 1 Department of Surgery, Semmelweis University, Budapest, Hungary
- * E-mail:
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Myoglobin casts in renal biopsies: immunohistochemistry and morphologic spectrum. Hum Pathol 2016; 54:25-30. [DOI: 10.1016/j.humpath.2016.02.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/16/2016] [Accepted: 02/24/2016] [Indexed: 11/22/2022]
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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.
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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
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Hayes C, Shafi H, Mason H, Klapper E. Successful reduction of plasma free-hemoglobin using therapeutic plasma exchange: A case report. Transfus Apher Sci 2016; 54:253-5. [DOI: 10.1016/j.transci.2015.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/21/2015] [Accepted: 08/25/2015] [Indexed: 11/28/2022]
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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.
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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:
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Carrillo-Esper R, Galván-Talamantes Y, Meza-Ayala CM, Cruz-Santana JA, Bonilla-Reséndiz LI. [Ultrasound findings in rhabdomyolysis]. CIR CIR 2016; 84:518-522. [PMID: 26772896 DOI: 10.1016/j.circir.2015.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 06/05/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Rhabdomyolysis is defined as skeletal muscle necrosis. Ultrasound assessment has recently become a useful tool for the diagnosis and monitoring of muscle diseases, including rhabdomyolysis. A case is presented on the ultrasound findings in a patient with rhabdomyolysis. OBJECTIVE To highlight the importance of ultrasound as an essential part in the diagnosis in rhabdomyolysis, to describe the ultrasound findings, and review the literature. CLINICAL CASE A 30 year-old with post-traumatic rhabdomyolysis of both thighs. Ultrasound was performed using a Philips Sparq model with a high-frequency linear transducer (5-10MHz), in low-dimensional scanning mode (2D), in longitudinal and transverse sections at the level of both thighs. The images obtained showed disorganisation of the orientation of the muscle fibres, ground glass image, thickening of the muscular fascia, and the presence of anechoic areas. CONCLUSIONS Ultrasound is a useful tool in the evaluation of rhabdomyolysis.
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Affiliation(s)
- Raúl Carrillo-Esper
- Unidad de Terapia Intensiva, Fundación Clínica Médica Sur, Tlalpan, Ciudad de México, México
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Akagi R, Akagi M, Hatori Y, Inouye S. Prevention of Barrier Disruption by Heme Oxygenase-1 in Intestinal Bleeding Model. Biol Pharm Bull 2016; 39:1007-12. [DOI: 10.1248/bpb.b15-01028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Reiko Akagi
- Department of Pharmacy, Faculty of Pharmacy, Yasuda Women’s University
| | - Masaaki Akagi
- Department of Pharmacology, Faculty of Pharmaceutical Science, Tokushima Bunri University
| | - Yuta Hatori
- Department of Pharmacy, Faculty of Pharmacy, Yasuda Women’s University
| | - Sachiye Inouye
- Department of Pharmacy, Faculty of Pharmacy, Yasuda Women’s University
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Rhabdomyolysis After Cosmetic Laser-Assisted Liposuction. Aesthetic Plast Surg 2015; 39:635-8. [PMID: 26085224 DOI: 10.1007/s00266-015-0511-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
Abstract
A 34-year-old-female patient visited our emergency room for symptoms of disturbance of urination and shortness of breath. She was diagnosed with rhabdomyolysis with acute kidney injury after laser-assisted liposuction and required hemodialysis. Although laser-assisted liposuction is a well-used procedure, it can cause local complications, such as burns and skin irregularities, as well as systemic complications, such as infection, fever, and emboli. However, laser-assisted, liposuction-induced rhabdomyolysis has not been reported. Repetitive exercises, trauma, and crush injury are the major causes of rhabdomyolysis. In this study, a unique case of rhabdomyolysis that developed after laser-assisted liposuction is reported.
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Bell R, Hanif F, Prasad P, Ahmad N. Red Kidney: Kidney Transplant From a Deceased Donor Who Received Massive Blood Transfusion During Cardiopulmonary Bypass. EXP CLIN TRANSPLANT 2015; 14:341-4. [PMID: 26030717 DOI: 10.6002/ect.2014.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Here, we present a case of a deceased-donor kidney transplant. The brain-dead donor had received a massive blood transfusion during cardiopulmonary bypass, which lead to hemolysis, hemoglobinuria, acute kidney injury, and renal replacement therapy. The kidney appeared red after in situ flush. Postoperatively, the recipient developed delayed graft function. Protocol biopsy during the postoperative period revealed the widespread deposition of heme pigment in the renal tubules. Massive blood transfusion and cardiopulmonary bypass surgery are associated with hemolysis and heme pigment deposition in the renal tubules, which subsequently lead to acute kidney injury. Kidneys from such donors appear red and, while this does not preclude transplant, are likely to develop delayed graft function.
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Affiliation(s)
- Richard Bell
- From the Division of Surgery, Department of Transplantation, St James' University Hospital, Leeds and United Kingdom
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Aranyi P, Turoczi Z, Garbaisz D, Lotz G, Geleji J, Hegedus V, Rakonczay Z, Balla Z, Harsanyi L, Szijarto A. Postconditioning in major vascular surgery: prevention of renal failure. J Transl Med 2015; 13:21. [PMID: 25622967 PMCID: PMC4314807 DOI: 10.1186/s12967-014-0379-7] [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: 06/25/2014] [Accepted: 12/30/2014] [Indexed: 01/16/2023] Open
Abstract
Background Postconditioning is a novel reperfusion technique to reduce ischemia-reperfusion injuries. The aim of the study was to investigate this method in an animal model of lower limb revascularization for purpose of preventing postoperative renal failure. Methods Bilateral lower limb ischemia was induced in male Wistar rats for 3 hours by infrarenal aorta clamping under narcosis. Revascularization was allowed by declamping the aorta. Postconditioning (additional 10 sec reocclusion, 10 sec reperfusion in 6 cycles) was induced at the onset of revascularization. Myocyte injury and renal function changes were assessed 4, 24 and 72 hours postoperatively. Hemodynamic monitoring was performed by invasive arterial blood pressure registering and a kidney surface laser Doppler flowmeter. Results Muscle viability studies showed no significant improvement with the use of postconditioning in terms of ischemic rhabdomyolysis (4 h: ischemia-reperfusion (IR) group: 42.93 ± 19.20% vs. postconditioned (PostC) group: 43.27 ± 27.13%). At the same time, renal functional laboratory tests and kidney myoglobin immunohistochemistry demonstrated significantly less expressed kidney injury in postconditioned animals (renal failure index: 4 h: IR: 2.37 ± 1.43 mM vs. PostC: 0.92 ± 0.32 mM; 24 h: IR: 1.53 ± 0.45 mM vs. PostC: 0.77 ± 0.34 mM; 72 h: IR: 1.51 ± 0.36 mM vs. PostC: 0.43 ± 0.28 mM), while systemic hemodynamics and kidney microcirculation significantly improved (calculated reperfusion area: IR: 82.31 ± 12.23% vs. PostC: 99.01 ± 2.76%), and arterial blood gas analysis showed a lesser extent systemic acidic load after revascularization (a defined relative base excess parameter: 1st s: IR: 2.25 ± 1.14 vs. PostC: 1.80 ± 0.66; 2nd s: IR: 2.14 ± 1.44 vs. PostC: 2.44 ± 1.14, 3rd s: IR: 3.99 ± 3.09 vs. PostC: 2.07 ± 0.82; 4th s: IR: 3.28 ± 0.32 vs. PostC: 2.05 ± 0.56). Conclusions The results suggest a protective role for postconditioning in major vascular surgeries against renal complications through a possible alternative release of nephrotoxic agents and exerting a positive effect on hemodynamic stability.
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Affiliation(s)
- Peter Aranyi
- 1st Department of Surgery, Semmelweis University, Budapest, Hungary.
| | - Zsolt Turoczi
- 1st Department of Surgery, Semmelweis University, Budapest, Hungary.
| | - David Garbaisz
- 1st Department of Surgery, Semmelweis University, Budapest, Hungary.
| | - Gabor Lotz
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary.
| | - Janos Geleji
- Eötvös Loránd University, Faculty of Science, Institute of Mathematics, Budapest, Hungary.
| | - Viktor Hegedus
- 1st Department of Surgery, Semmelweis University, Budapest, Hungary.
| | - Zoltan Rakonczay
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary.
| | - Zsolt Balla
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary.
| | - Laszlo Harsanyi
- 1st Department of Surgery, Semmelweis University, Budapest, Hungary.
| | - Attila Szijarto
- 1st Department of Surgery, Semmelweis University, Budapest, Hungary.
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Bowyer JF, Hanig JP. Amphetamine- and methamphetamine-induced hyperthermia: Implications of the effects produced in brain vasculature and peripheral organs to forebrain neurotoxicity. Temperature (Austin) 2014; 1:172-82. [PMID: 27626044 PMCID: PMC5008711 DOI: 10.4161/23328940.2014.982049] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 10/22/2014] [Accepted: 10/27/2014] [Indexed: 12/20/2022] Open
Abstract
The adverse effects of amphetamine- (AMPH) and methamphetamine- (METH) induced hyperthermia on vasculature, peripheral organs and peripheral immune system are discussed. Hyperthermia alone does not produce amphetamine-like neurotoxicity but AMPH and METH exposures that do not produce hyperthermia (≥40°C) are minimally neurotoxic. Hyperthermia likely enhances AMPH and METH neurotoxicity directly through disruption of protein function, ion channels and enhanced ROS production. Forebrain neurotoxicity can also be indirectly influenced through the effects of AMPH- and METH- induced hyperthermia on vasculature. The hyperthermia and the hypertension produced by high doses amphetamines are a primary cause of transient breakdowns in the blood-brain barrier (BBB) resulting in concomitant regional neurodegeneration and neuroinflammation in laboratory animals. This BBB breakdown can occur in the amygdala, thalamus, striatum, sensory and motor cortex and hippocampus. Under these conditions, repetitive seizures greatly enhance neurodegeneration in hippocampus, thalamus and amygdala. Even when the BBB is less disrupted, AMPH- or METH- induced hyperthermia effects on brain vasculature may play a role in neurotoxicity. In this case, striatal and cortical vascular function are adversely affected, and even greater ROS, immune and damage responses are seen in the meninges and cortical surface vasculature. Finally, muscle and liver damage and elevated cytokines in blood can result when amphetamines produce hyperthermia. Proteins, from damaged muscle may activate the peripheral immune system and exacerbate liver damage. Liver damage can further increase cytokine levels, immune system activation and increase ammonia levels. These effects could potentially enhance vascular damage and neurotoxicity.
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Petejova N, Martinek A. Acute kidney injury due to rhabdomyolysis and renal replacement therapy: a critical review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:224. [PMID: 25043142 PMCID: PMC4056317 DOI: 10.1186/cc13897] [Citation(s) in RCA: 225] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Rhabdomyolysis, a clinical syndrome caused by damage to skeletal muscle and release of its breakdown products into the circulation, can be followed by acute kidney injury (AKI) as a severe complication. The belief that the AKI is triggered by myoglobin as the toxin responsible appears to be oversimplified. Better knowledge of the pathophysiology of rhabdomyolysis and following AKI could widen treatment options, leading to preservation of the kidney: the decision to initiate renal replacement therapy in clinical practice should not be made on the basis of the myoglobin or creatine phosphokinase serum concentrations.
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Zutt R, van der Kooi AJ, Linthorst GE, Wanders RJA, de Visser M. Rhabdomyolysis: review of the literature. Neuromuscul Disord 2014; 24:651-9. [PMID: 24946698 DOI: 10.1016/j.nmd.2014.05.005] [Citation(s) in RCA: 228] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/02/2014] [Accepted: 05/13/2014] [Indexed: 12/18/2022]
Abstract
Rhabdomyolysis is a serious and potentially life threatening condition. Although consensus criteria for rhabdomyolysis is lacking, a reasonable definition is elevation of serum creatine kinase activity of at least 10 times the upper limit of normal followed by a rapid decrease of the sCK level to (near) normal values. The clinical presentation can vary widely, classical features are myalgia, weakness and pigmenturia. However, this classic triad is seen in less than 10% of patients. Acute renal failure due to acute tubular necrosis as a result of mechanical obstruction by myoglobin is the most common complication, in particular if sCK is >16.000 IU/l, which may be as high as 100,000 IU/l. Mortality rate is approximately 10% and significantly higher in patients with acute renal failure. Timely recognition of rhabdomyolysis is key for treatment. In the acute phase, treatment should be aimed at preserving renal function, resolving compartment syndrome, restoring metabolic derangements, and volume replacement. Most patients experience only one episode of rhabdomyolysis, mostly by substance abuse, medication, trauma or epileptic seizures. In case of recurrent rhabdomyolysis, a history of exercise intolerance or a positive family history for neuromuscular disorders, further investigations are needed to identify the underlying, often genetic, disorder. We propose a diagnostic algorithm for use in clinical practice.
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Affiliation(s)
- R Zutt
- Department of Neurology, Academic Medical Center, University of Amsterdam/University Medical Center Groningen, The Netherlands
| | - A J van der Kooi
- Department of Neurology, Academic Medical Center, University of Amsterdam, The Netherlands.
| | - G E Linthorst
- Department of Internal Medicine/Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, The Netherlands
| | - R J A Wanders
- Department of Paediatrics and Clinical Chemistry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - M de Visser
- Department of Neurology, Academic Medical Center, University of Amsterdam, The Netherlands
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49
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Disaster nephrology: crush injury and beyond. Kidney Int 2013; 85:1049-57. [PMID: 24107850 DOI: 10.1038/ki.2013.392] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/20/2013] [Accepted: 07/25/2013] [Indexed: 01/09/2023]
Abstract
Disasters result in a substantial number of renal challenges, either by the creation of crush injury in victims trapped in collapsed buildings or by the destruction of existing dialysis facilities, leaving chronic dialysis patients without access to their dialysis units, medications, or medical care. Over the past two decades, lessons have been learned from the response to a number of major natural disasters that have impacted significantly on crush-related acute kidney injury and chronic dialysis patients. In this paper we review the pathophysiology and treatment of the crush syndrome, as summarized in recent clinical recommendations for the management of crush syndrome. The importance of early fluid resuscitation in preventing acute kidney injury is stressed, logistic difficulties in disaster conditions are described, and the need for an implementation of a renal disaster relief preparedness program is underlined. The role of the Renal Disaster Relief Task Force in providing emergency disaster relief and the logistical support required is outlined. In addition, the importance of detailed education of chronic dialysis patients and renal unit staff in the advance planning for such disasters and the impact of displacement by disasters of chronic dialysis patients are discussed.
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Chen CY, Lin YR, Zhao LL, Yang WC, Chang YJ, Wu KH, Wu HP. Clinical spectrum of rhabdomyolysis presented to pediatric emergency department. BMC Pediatr 2013; 13:134. [PMID: 24004920 PMCID: PMC3766249 DOI: 10.1186/1471-2431-13-134] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 08/30/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Rhabdomyolysis is a potentially life-threatening syndrome that can develop from a variety of causes. The aim of the work is to analyze the clinical spectrum and to evaluate the prevalence of various etiologies in children, who present to the emergency department (ED) with rhabdomyolysis. METHODS During a 6-year study period, we retrospectively analyzed the medical charts of patients, aged 18 years or younger, with a definite diagnosis of rhabdomyolysis and serum creatinine phosphokinase (CK) levels greater than 1000IU/L. We analyzed the clinical spectrum and evaluated the potential risk factors of acute renal failure (ARF). RESULTS Thirty-seven patients (mean age = 10.2 ± 5.5 years), including 26 males and 11 females, were enrolled in the study. Two of the most common presented symptoms in these 37 patients were muscle pain and muscle weakness (83.8% and 73%, respectively). Dark urine was reported in only 5.4% of the patients. The leading cause of rhabdomyolysis in the 0- to 9-year age group was presumed infection, and the leading cause in the 10- to 18-year age group was trauma and exercise. The incidence of ARF associated with rhabdomyolysis was 8.1 % and no child needed for renal replacement therapy (RRT). We did not identify any reliable predictors of ARF or need for RRT. CONCLUSIONS The classic triad of symptoms of rhabdomyolysis includes myalgia, weakness and dark urine are not always presented in children. The cause of rhabdomyolysis in younger age is different from that of teenager group. However, the prognosis of rhabdomyolysis was good with appropriate management.
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Affiliation(s)
- Chun-Yu Chen
- Division of Emergency Medicine, Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yan-Ren Lin
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan
- Department of Biological Science and Technology and Institute of Biochemical Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Lu-Lu Zhao
- Department of Pediatrics, Taipei Tzuchi Hospital, the Buddhist Medical Foundation, Taipei, Taiwan
| | - Wen-Chieh Yang
- Division of Emergency Medicine, Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Jun Chang
- Laboratory of Epidemiology and Biostastics, Changhua Christian Hospital, Changhua, Taiwan
| | - Kang-Hsi Wu
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Han-Ping Wu
- Department of Pediatrics, Taichung Tzuchi Hospital, the Buddhist Medical Foundation, Taichung, Taiwan
- Department of Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
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