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Kumthekar GV, Shukla U, Purandare V. Rhabdomyolysis-Induced Acute Kidney Injury Treated with Medium Cut-Off Membrane: A Case Report. Indian J Nephrol 2023; 33:468-471. [PMID: 38174295 PMCID: PMC10752406 DOI: 10.4103/ijn.ijn_151_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/13/2022] [Accepted: 07/30/2022] [Indexed: 01/05/2024] Open
Abstract
Acute kidney injury can complicate rhabdomyolysis in 10-40% patients. Myoglobinuria and elevated creatine kinase (CK) form the basis of diagnosis. When associated with azotemia and/or oliguria, intermittent hemodialysis is a treatment option. 31-year-old young man came with lower limb pain after doing 800 sit ups. At the presentation, blood pressure was high, serum creatinine was 15.7mg/dl and creatine kinase(CK)>20000 IU/L. Intermittent dialysis was initiated. He developed posterior reversible encephalopathy syndrome, generalized tonic clonic convulsions and a further rise in CK. He underwent extracorporeal removal of myoglobin with medium cut-off (MCO) membrane. After 3 sessions with MCO membrane, myoglobin and CK levels reduced. He was transitioned to conventional dialysis and discharged in a stable condition with complete renal recovery. Medium cut-off membrane effectively removes circulating myoglobin without significant albumin loss and is cost effective.
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Affiliation(s)
- Girish V. Kumthekar
- Department of Nephrology, Symbiosis University Hospital and Research Center (SUHRC), Symbiosis Medical College for Women (SMCW), Symbiosis International University (SIU), Lavale, Pune, Maharashtra, India
| | - Urvi Shukla
- Department of Critical Care Medicine, Symbiosis University Hospital and Research Center (SUHRC), Symbiosis Medical College for Women (SMCW), Symbiosis International University (SIU), Lavale, Pune, Maharashtra, India
| | - Veena Purandare
- Department of Internal Medicine, Symbiosis University Hospital and Research Center (SUHRC), Symbiosis Medical College for Women (SMCW), Symbiosis International University (SIU), Lavale, Pune, Maharashtra, India
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Zahran NA, Jadidi S. Pediatric Hyperglycemic Hyperosmolar Syndrome: A Comprehensive Approach to Diagnosis, Management, and Complications Utilizing Novel Summarizing Acronyms. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1773. [PMID: 38002864 PMCID: PMC10670661 DOI: 10.3390/children10111773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 11/26/2023]
Abstract
This paper focuses on hyperglycemic hyperosmolar syndrome (HHS), a unique hyperglycemic state requiring divergent diagnosis and treatment approaches from diabetic ketoacidosis (DKA) despite some shared characteristics. We introduce the mnemonic DI-FF-ER-EN-CE-S to encapsulate unique HHS management and complications. 'DI' emphasizes the need to delay and decrease initial insulin therapy until serum glucose decline is managed by fluid resuscitation alone. 'FF' stresses the importance of double fluid replacement compared to DKA due to severe dehydration and 'ER' electrolyte replacement due to profound losses and imbalances. 'EN' denotes the potential for encephalopathy and the requirement for a controlled serum osmolality reduction. 'CE' indicates cerebral edema, a rare complication in HHS. 'S' signifies systemic multiorgan failure. We categorize the associated risks into three mnemonic groups: the 3Rs (renal failure, respiratory distress, rhabdomyolysis), the 3Hs (heart failure, hypercoagulation, hyperthermia), and AP (arrhythmias, pancreatitis) to facilitate awareness and screening of HHS.
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Affiliation(s)
- Naser Amin Zahran
- Lurie Children’s at Northwestern Medicine Central DuPage Hospital, Winfield, IL 60190, USA;
| | - Shaheen Jadidi
- Loyola University Medical Center, Maywood, IL 60153, USA
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3
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Kozik I, Wikerd Z. Extremely elevated creatine kinase associated with rhabdomyolysis-induced acute kidney injury in a patient with Huntington's disease: a case report. J Med Case Rep 2023; 17:287. [PMID: 37424016 DOI: 10.1186/s13256-023-04018-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 06/01/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Rhabdomyolysis-induced acute kidney injury is a serious condition that can progress to acute renal failure if not promptly identified and treated. Rhabdomyolysis occurs when serum creatine kinase levels approach > 1000 U/L (five times the normal upper limit). The chance of acute kidney injury increases as the levels of creatine kinase increase. Although Huntington's disease is associated with muscle atrophy, elevated baseline creatine kinase levels in these patients have not been routinely reported. CASE PRESENTATION A 31-year-old African American patient presented to the emergency department after he was found unconscious from a fall attributed to the progression of his Huntington's disease. On admission, he had an extremely high creatine kinase level of 114,400 U/L and was treated with fluids, electrolyte balance, and dialysis. However, his condition progressed to acute renal failure and he later developed posterior reversible encephalopathy syndrome, requiring transfer to the intensive care unit with placement on continuous renal replacement therapy. Eventually, his kidney function recovered and he was discharged home with 24/7 care by his family for persistent impairments related to his Huntington's disease. CONCLUSIONS This case report underscores the importance of promptly recognizing elevated creatine kinase levels in patients with Huntington's disease due to the risk of developing rhabdomyolysis-induced acute kidney injury. If not aggressively treated, the condition of these patients is likely to progress to renal failure. Anticipating the progression of rhabdomyolysis-induced acute kidney injury is paramount to improving clinical outcomes. Additionally, this case identifies a potential link between the patient's Huntington's disease and his abnormally elevated creatine kinase, a finding not described in the literature of rhabdomyolysis-induced kidney injuries to date and an important consideration for future patients with similar comorbidities.
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Affiliation(s)
- Isabelle Kozik
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 14203, USA.
| | - Zachary Wikerd
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 14215, USA
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Harmer MJ, Nijloveanu V, Thodi E, Ding WY, Longthorpe C, Fenton-Jones M, Hogg K, Day A, Platt C. Paediatric rhabdomyolysis: A UK centre's 10-year retrospective experience. J Paediatr Child Health 2023; 59:346-351. [PMID: 36504419 DOI: 10.1111/jpc.16303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/30/2022] [Accepted: 11/19/2022] [Indexed: 12/14/2022]
Abstract
AIMS To describe the aetiologies of paediatric rhabdomyolysis and explore the medium-term renal consequences. METHODS Retrospective, single-centre review of children with rhabdomyolysis. RESULTS Two hundred and thirty-two children met inclusion criteria for the analysis. Mean age at presentation was 8.4 (SD ± 5.5) years. The commonest aetiology was infection (28%), with viral myositis making up the clear majority (75%). Trauma was identified as a cause in 18% of children, seizures in 10% and immune-mediated mechanisms in 8%. Acute kidney injury (AKI) was present in 32% of the cases overall. Children with AKI tended to be younger, with higher peak creatine kinase (CK) and active urinary sediment on urinalysis at presentation. AKI and the need for renal replacement therapy (RRT) were associated with a prolonged hospital stay (15 (interquartile range, IQR 6.5-33) vs. 2 (IQR 0-7) days). A total of 18 children and young people required RRT, with a mean duration of 7.1 ± 4.3 days. Those who received RRT were more likely to have abnormalities on urinalysis at presentation (46% vs. 5%). Over the period of the study, 9% of children died and 2% met criteria for a diagnosis of chronic kidney disease. CONCLUSIONS This large paediatric rhabdomyolysis case series provides new and unique insights into the condition. Our results highlight the common aetiologies and provide evidence of good renal recovery overall, even in the most severely affected cases. Abnormalities of urinalysis appear to be important in predicting the development of AKI and the need for RRT.
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Affiliation(s)
- Matthew J Harmer
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, United Kingdom.,Department of Paediatric Nephrology, Southampton Children's Hospital, Southampton, United Kingdom
| | - Veronica Nijloveanu
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Eftychia Thodi
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Wen Y Ding
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Catherine Longthorpe
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Mary Fenton-Jones
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Kirstin Hogg
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Andrew Day
- University Hospital Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Caroline Platt
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, United Kingdom
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Abstract
A 76-year-old lady was found on the floor following a fall at home. She was uninjured, but unable to get up, and had been lying on the floor for roughly 18 hours before her son arrived. She had been unwell for the past 3 days with a cough and shortness of breath. She had a past medical history of diabetes, hypertension, hypercholesterolaemia and atrial fibrillation (AF). On examination, she was alert but distressed, clinically dehydrated, febrile and tachycardic. She was treated for community acquired pneumonia with co-amoxiclav and was fluid resuscitated with Hartmann's solution. Her hyperkalaemia was treated with 50 mL of 50% glucose containing 10 units of rapid-acting insulin. Her creatinine kinase (CK) on admission was 200,000, and she had an acute kidney injury (AKI). Urine dipstick was positive for blood. However, her renal function continued to deteriorate over the succeeding 48 h, when she required renal replacement therapy (RRT) due to fluid overload and anuria.
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Affiliation(s)
- Sarah Burgess
- Sarah Burgess, Department of Anaesthesia,
University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry
CV2 2DX, UK.
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Xue L, Guo W, Li L, Ou S, Zhu T, Cai L, Ding W, Wu W. Metabolomic profiling identifies a novel mechanism for heat stroke‑related acute kidney injury. Mol Med Rep 2021; 23:241. [PMID: 33655337 PMCID: PMC7893796 DOI: 10.3892/mmr.2021.11880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/20/2020] [Indexed: 11/27/2022] Open
Abstract
Heat stroke can induce a systemic inflammatory response, which may lead to multi‑organ dysfunction including acute kidney injury (AKI) and electrolyte disturbances. To investigate the pathogenesis of heat stroke (HS)‑related AKI, a mouse model of HS was induced by increasing the animal's core temperature to 41˚C. Blood samples obtained from the tail vein were used to measure plasma glucose and creatinine levels. Micro‑positron emission tomography‑computed tomography (micro‑PET/CT), H&E staining and transmission electron microscopy were conducted to examine metabolic and morphological changes in the mouse kidneys. Immunohistochemistry (IHC) and western blot analyses were performed to investigate the expression of apoptosis‑inducing factor mitochondria‑associated 2 (Aifm2), high‑mobility group box 1 (HMGB1) and receptor for advanced glycosylation end products (RAGE). Liquid chromatography‑mass spectrometry analysis was conducted to find differential metabolites and signaling pathways. The HS mouse model was built successfully, with significantly increased creatinine levels detected in the serum of HS mice compared with controls, whereas micro‑PET/CT revealed active metabolism in the whole body of HS mice. H&E and TUNEL staining revealed that the kidneys of HS mice exhibited signs of hemorrhage and apoptosis. IHC and western blotting demonstrated significant upregulation of Aifm2, HMGB1 and RAGE in response to HS. Finally, 136 differential metabolites were screened out, and enrichment of the 'biosynthesis of unsaturated fatty acids' pathway was detected. HS‑associated AKI is the renal manifestation of systemic inflammatory response syndrome, and may be triggered by the HMGB1/RAGE pathway. Metabolomics indicated increased adrenic acid, docosahexaenoic acid and eicosapentaenoic acid may serve as metabolic biomarkers for AKI in HS. The findings suggested that a correlation between the HMGB1/RAGE pathway and biosynthesis of unsaturated fatty acids may contribute to the progression of HS‑related AKI.
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Affiliation(s)
- Ling Xue
- Department of Urology, Sichuan Clinical Research Center for Nephropathy, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Wenli Guo
- Department of Nephrology, Sichuan Clinical Research Center for Nephropathy, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Li Li
- Department of Nephrology, Sichuan Clinical Research Center for Nephropathy, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Santao Ou
- Department of Nephrology, Sichuan Clinical Research Center for Nephropathy, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Tingting Zhu
- Department of Nephrology, Sichuan Clinical Research Center for Nephropathy, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Liang Cai
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Wenfei Ding
- Department of Nephrology, Sichuan Clinical Research Center for Nephropathy, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Weihua Wu
- Department of Nephrology, Sichuan Clinical Research Center for Nephropathy, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
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7
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Waldman W, Kabata PM, Dines AM, Wood DM, Yates C, Heyerdahl F, Hovda KE, Giraudon I, Dargan PI, Sein Anand J. Rhabdomyolysis related to acute recreational drug toxicity-A Euro-DEN study. PLoS One 2021; 16:e0246297. [PMID: 33705425 PMCID: PMC7951866 DOI: 10.1371/journal.pone.0246297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background This study was conducted to retrospectively assess the relationships between: rhabdomyolysis (quantified by creatine kinase (CK) activity) and kidney injury (quantified by serum creatinine concentration), sex, age, body temperature on admission, presence of seizures, and agitation or aggression in patients presenting to the Emergency Department with acute recreational drug toxicity. We also investigated the association with the substances ingested. Methods All presentations to the 16 sentinel Euro-DEN centres in 10 European countries with acute recreational drug toxicity during the first year of the Euro-DEN study (October 2013 to September 2014) were considered. Cases that had abnormal CK activity recorded as part of routine clinical care were divided into 3 cohorts depending on peak CK activity. Cases with normal CK activity were included as a control group (4th cohort). Results Only 1,015 (18.4%) of the 5,529 Euro-DEN presentations had CK activity concentration recorded. Of this group 353 (34.8%) had also creatinine concentration measured. There were 375 (36.9%) with minor rhabdomyolysis, 69 (6.8%) with moderate rhabdomyolysis, and 24 (2.4%) with severe rhabdomyolysis; 547 (53.9%) were included in the control group. There was a positive correlation between CK activity and creatinine concentration (correlation coefficient r = 0.71, p<0.0001). There was no correlation between CK activity and body temperature at the time of presentation to the ED (correlation coefficient r = 0.07, p = 0.03). There was a positive correlation between CK activity and length of stay in the hospital (r = 0.31, p<0.001). There was no association between CK activity and the presence of seizures (p = 0.33) or agitation/aggression (p = 0.45), patients age (p = 0.4) or sex (p = 0.25). The 5 most common agents amongst patients presenting with rhabdomyolysis were: cocaine (n = 107; 22.9% presentations), amphetamine (76; 16.2%), cannabis (74; 15.8%), GHB/GBL (72; 15.4%) and heroin (67; 14.3%). The distribution of rhabdomyolysis in 5 most common drugs was (drug; patients with rhabdomyolysis, patients without rhabdomyolysis): cocaine (107, 122), cannabis (74, 117), GHB/GBL (72, 81), amphetamine (76, 66), heroin (67, 70). Conclusions Abnormal values of CK activity occurred in almost half (46.1%) of presentations to the Emergency Department with acute recreational drug toxicity in whom CK activity was measured; however, severe rhabdomyolysis is seen in only a small minority (2.4%). Those with rhabdomyolysis are at significantly higher risk of kidney injury and have a longer length of hospital stay.
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Affiliation(s)
- Wojciech Waldman
- Department of Clinical Toxicology, Medical University of Gdansk, Gdansk, Poland.,Pomeranian Centre of Toxicology, Gdansk, Poland
| | | | - Alison M Dines
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, United Kingdom
| | - David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, United Kingdom.,Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | | | | | | | - Isabelle Giraudon
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | | | - Paul I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, United Kingdom.,Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Jacek Sein Anand
- Department of Clinical Toxicology, Medical University of Gdansk, Gdansk, Poland.,Pomeranian Centre of Toxicology, Gdansk, Poland
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Candela N, Silva S, Georges B, Cartery C, Robert T, Moussi-Frances J, Rondeau E, Rebibou JM, Lavayssiere L, Belliere J, Krummel T, Lebas C, Cointault O, Sallee M, Faguer S. Short- and long-term renal outcomes following severe rhabdomyolysis: a French multicenter retrospective study of 387 patients. Ann Intensive Care 2020; 10:27. [PMID: 32124091 PMCID: PMC7052098 DOI: 10.1186/s13613-020-0645-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 02/24/2020] [Indexed: 12/18/2022] Open
Abstract
Background Rhabdomyolysis is a life-threatening disease that can lead to severe hyperkalemia, acute kidney injury (AKI) and hypovolemic shock. The predictive factors of AKI and acute to chronic kidney disease (CKD) transition remain poorly described. Methods This multicenter retrospective study enrolled 387 patients with severe rhabdomyolysis (CPK > 5000 U/L). Primary end-point was the development of severe AKI, defined as stage 2 or 3 of KDIGO classification. Secondary end-points included the incidence of AKI to CKD transition. Results Among the 387 patients, 315 (81.4%) developed AKI, including 171 (44.1%) with stage 3 AKI and 103 (26.6%) requiring RRT. Stage 2–3 AKI was strongly correlated with serum phosphate, potassium and bicarbonate at admission, as well as myoglobin over 8000 U/L and the need for mechanical ventilation. 42 patients (10.8%) died before day 28. In the 80 patients with available eGFR values both before and 3 months after the rhabdomyolysis, the decrease in eGFR (greater than 20 mL/min/1.73 m2 in 23 patients; 28.8%) was correlated to the severity of the AKI and serum myoglobin levels > 8000 U/L at admission. Conclusions Severe rhabdomyolysis leads to AKI in most patients admitted to an ICU. Mechanical ventilation and severity of the rhabdomyolysis, including myoglobin level, are associated with the risk of stage 2–3 AKI. The long-term renal decline is correlated to serum myoglobin at admission.
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Affiliation(s)
- Nelly Candela
- Département de Néphrologie et Transplantation d'organes, Hôpital Rangueil, Intensive Care Unit, Centre Hospitalo-Universitaire de Toulouse, 1, Avenue Jean Poulhes, 31059, Toulouse, France
| | - Stein Silva
- Réanimation-URM, Hôpital Purpan, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Bernard Georges
- Département d'Anesthésie et Réanimation-Unité de Réanimation Polyvalente, Hôpital Rangueil, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Claire Cartery
- Service de Néphrologie, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Thomas Robert
- Service de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Centre Hospitalo-Universitaire de Marseille, Marseille, France
| | - Julie Moussi-Frances
- Service de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Centre Hospitalo-Universitaire de Marseille, Marseille, France
| | - Eric Rondeau
- Service d'Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Jean-Michel Rebibou
- Service de Néphrologie, Centre Hospitalo-Universitaire de Dijon, Dijon, France
| | - Laurence Lavayssiere
- Département de Néphrologie et Transplantation d'organes, Hôpital Rangueil, Intensive Care Unit, Centre Hospitalo-Universitaire de Toulouse, 1, Avenue Jean Poulhes, 31059, Toulouse, France
| | - Julie Belliere
- Département de Néphrologie et Transplantation d'organes, Hôpital Rangueil, Intensive Care Unit, Centre Hospitalo-Universitaire de Toulouse, 1, Avenue Jean Poulhes, 31059, Toulouse, France
| | - Thierry Krummel
- Service de Néphrologie, Centre Hospitalo-Universitaire de Strasbourg, Strasbourg, France
| | - Céline Lebas
- Service de Néphrologie, Centre Hospitalo-Universitaire de Lille, Lille, France
| | - Olivier Cointault
- Département de Néphrologie et Transplantation d'organes, Hôpital Rangueil, Intensive Care Unit, Centre Hospitalo-Universitaire de Toulouse, 1, Avenue Jean Poulhes, 31059, Toulouse, France
| | - Marion Sallee
- Service de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Centre Hospitalo-Universitaire de Marseille, Marseille, France.,Institut National de la Science et de la Recherche Médicale, Institut National de la recherche Agronomique, Université Aix-Marseille, C2VN, Marseille, France
| | - Stanislas Faguer
- Département de Néphrologie et Transplantation d'organes, Hôpital Rangueil, Intensive Care Unit, Centre Hospitalo-Universitaire de Toulouse, 1, Avenue Jean Poulhes, 31059, Toulouse, France. .,Institut National de la Science et de la Recherche Médicale, Unité 1048 (équipe 12-Fibrose rénale: détection et mécanismes de progression), Paris, France.
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Velez J, Obadan N, Kaushal A, Alzubaidi M, Bhasin B, Sachdev S, Karakala N, Arthur J, Nesbit R, Phadke G. Vancomycin-Associated Acute Kidney Injury with a Steep Rise in Serum Creatinine. Nephron Clin Pract 2018; 139:131-142. [DOI: 10.1159/000487149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/24/2018] [Indexed: 01/09/2023] Open
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Kazancioğlu R, Korular D, Sever M, Türkmen A, Aysuna N, Kayacan S, Tahin S, Yildiz A, Bozfakioğlu S, Ark E. The Outcome of Patients Presenting with Crush Syndrome after the Marmara Earthquake. Int J Artif Organs 2018. [DOI: 10.1177/039139880102400104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this study, we evaluated the clinical and laboratory data of the patients presenting after the Marmara earthquake. Crush syndrome was diagnosed in 60 patients (30 M, 30 F, mean age: 31.3±13.8 years). They were buried under the rubble for a mean period of 12.3±15.1 hours. On admission, 27 patients were oligoanuric and the mean serum creatinine, creatinine phosphokinase and potassium levels were 4.4±3.2 mg/dl, 18453.1±24527.2 IU/L, and 4.9±1.7 mEq/L, respectively. The most frequent site of trauma was the lower extremity. Dialysis treatment was initiated in 40 patients (19 M, 21 F, mean age: 32.7±13.0 years). Mean number of hemodialysis sessions/patient was 8.9±6.8. Nine (23%) patients among the dialyzed and 4 (20%) among the non-dialyzed died leading to an overall mortality of 21.6%. This low mortality rate suggests that the death rate from acute renal failure due to crush syndrome could be decreased by extensive follow-up.
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Affiliation(s)
- R. Kazancioğlu
- Division of Nephrology, Department of Internal Medicine, Istanbul School of Medicine, Istanbul - Turkey
| | - D. Korular
- Division of Nephrology, Department of Internal Medicine, Istanbul School of Medicine, Istanbul - Turkey
| | - M.Ş. Sever
- Division of Nephrology, Department of Internal Medicine, Istanbul School of Medicine, Istanbul - Turkey
| | - A. Türkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul School of Medicine, Istanbul - Turkey
| | - N. Aysuna
- Division of Nephrology, Department of Internal Medicine, Istanbul School of Medicine, Istanbul - Turkey
| | - S.M. Kayacan
- Division of Nephrology, Department of Internal Medicine, Istanbul School of Medicine, Istanbul - Turkey
| | - S. Tahin
- Division of Nephrology, Department of Internal Medicine, Istanbul School of Medicine, Istanbul - Turkey
| | - A. Yildiz
- Division of Nephrology, Department of Internal Medicine, Istanbul School of Medicine, Istanbul - Turkey
| | - S. Bozfakioğlu
- Division of Nephrology, Department of Internal Medicine, Istanbul School of Medicine, Istanbul - Turkey
| | - E. Ark
- Division of Nephrology, Department of Internal Medicine, Istanbul School of Medicine, Istanbul - Turkey
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11
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Sakthirajan R, Dhanapriya J, Varghese A, Saravanakumar K, Dineshkumar T, Balasubramaniyan T, Gopalakrishnan N, Abraham Kurien A. Clinical profile and outcome of pigment-induced nephropathy. Clin Kidney J 2017; 11:348-352. [PMID: 29942498 PMCID: PMC6007272 DOI: 10.1093/ckj/sfx121] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 09/07/2017] [Indexed: 12/21/2022] Open
Abstract
Background Pigment nephropathy represents one of the most severe complications of rhabdomyolysis or hemolysis. Methods We performed a retrospective observational study to analyze the etiology, clinical manifestation, laboratory profile and outcome in patients with biopsy-proven pigment-induced nephropathy between January 2011 and December 2016. History, clinical examination findings, laboratory investigations and outcome were recorded. Results A total of 46 patients were included with mean follow-up of 14 ± 5.5 months. Mean age was 40.15 ± 12.3 years, 65% were males (male:female, 1.8:1) and ∼37 (80.4%) had oliguria. Mean serum creatinine at presentation and peak creatinine were 7.5 ± 2.2 and 12.1 ± 4.3 mg/dL, respectively. Evidence of rhabdomyolysis was noted in 26 patients (64%) and hemolysis in 20 patients (36%). Etiology of rhabdomyolysis include snake envenomation (10 patients), seizures (7), strenuous exercise (5), wasp sting (2) and rifampicin induced (2). The causes of hemolysis include rifampicin induced (7 patients), sepsis (5), malaria (3), mismatched blood transfusion/transfusion reaction (3) and paroxysmal nocturnal hemoglobinuria (2). On renal biopsy, two patients had acute interstitial nephritis and two had immunoglobulin A deposits in addition to pigment nephropathy. All except one (97.8%) required hemodialysis (HD) during hospital stay and mean number of HD sessions was 9 ± 2. A total of three patients with sepsis/disseminated intravascular coagulation died, all had associated hemolysis. On statistical analysis, there was no difference between AKI due to rhabdomyolysis and hemolysis except for high creatine phosphokinase in patients with rhabdomyolysis and Lactate dehydrogenase level in patients with hemolysis. At mean follow-up, five patients (12%) progressed to chronic kidney disease (CKD). Conclusions Pigment nephropathy due to rhabdomyolysis and hemolysis is an important cause of renal failure requiring HD. The prognosis was relatively good and depends on the etiology; however, long-term studies and follow-up are needed to assess the true incidence of CKD due to pigment nephropathy.
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Affiliation(s)
- Ramanathan Sakthirajan
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India
| | - Jeyachandran Dhanapriya
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India
| | - Arun Varghese
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India
| | - Karunamoorthy Saravanakumar
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India
| | - Thanigachalam Dineshkumar
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India
| | - Thopalan Balasubramaniyan
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India
| | - Natarajan Gopalakrishnan
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India
| | - Anila Abraham Kurien
- Department of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India
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12
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Nusshag C, Weigand MA, Zeier M, Morath C, Brenner T. Issues of Acute Kidney Injury Staging and Management in Sepsis and Critical Illness: A Narrative Review. Int J Mol Sci 2017; 18:E1387. [PMID: 28657585 PMCID: PMC5535880 DOI: 10.3390/ijms18071387] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 06/24/2017] [Accepted: 06/24/2017] [Indexed: 12/19/2022] Open
Abstract
Acute kidney injury (AKI) has a high incidence on intensive care units around the world and is a major complication in critically ill patients suffering from sepsis or septic shock. The short- and long-term complications are thereby devastating and impair the quality of life. Especially in terms of AKI staging, the determination of kidney function and the timing of dialytic AKI management outside of life-threatening indications are ongoing matters of debate. Despite several studies, a major problem remains in distinguishing between beneficial and unnecessary "early" or even harmful renal replacement therapy (RRT). The latter might prolong disease course and renal recovery. AKI scores, however, provide an insufficient outcome-predicting ability and the related estimation of kidney function via serum creatinine or blood urea nitrogen (BUN)/urea is not reliable in AKI and critical illness. Kidney independent alterations of creatinine- and BUN/urea-levels further complicate the situation. This review critically assesses the current AKI staging, issues and pitfalls of the determination of kidney function and RRT timing, as well as the potential harm reflected by unnecessary RRT. A better understanding is mandatory to improve future study designs and avoid unnecessary RRT for higher patient safety and lower health care costs.
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Affiliation(s)
- Christian Nusshag
- Department of Nephrology, Heidelberg University Hospital, 162, Im Neuenheimer Feld, D-69120 Heidelberg, Germany.
| | - Markus A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, 110, Im Neuenheimer Feld, D-69120 Heidelberg, Germany.
| | - Martin Zeier
- Department of Nephrology, Heidelberg University Hospital, 162, Im Neuenheimer Feld, D-69120 Heidelberg, Germany.
| | - Christian Morath
- Department of Nephrology, Heidelberg University Hospital, 162, Im Neuenheimer Feld, D-69120 Heidelberg, Germany.
| | - Thorsten Brenner
- Department of Anesthesiology, Heidelberg University Hospital, 110, Im Neuenheimer Feld, D-69120 Heidelberg, Germany.
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13
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Wang S, Zhang C, Li J, Niyazi S, Zheng L, Xu M, Rong R, Yang C, Zhu T. Erythropoietin protects against rhabdomyolysis-induced acute kidney injury by modulating macrophage polarization. Cell Death Dis 2017; 8:e2725. [PMID: 28383559 PMCID: PMC5477572 DOI: 10.1038/cddis.2017.104] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/02/2017] [Accepted: 02/15/2017] [Indexed: 12/15/2022]
Abstract
Erythropoietin (EPO) is a well-known hormone that is clinically used for the treatment of anemia. Very recently, an increasing body of evidence showed that EPO could still regulate bioactivities of macrophages. However, the details about the immunomodulatory effect of EPO on macrophages are not fully delineated, particularly in the setting of renal damages. Therefore, in the present study, we determined whether EPO could exert an impact on the dynamics of macrophages in a well-established model of rhabdomyolysis-induced acute kidney injury and explored the potential mechanisms. EPO was found to ameliorate kidney injuries by reducing macrophages recruitment and promoting phenotype switch toward M2 macrophages in vivo. It was also confirmed that EPO could directly suppress pro-inflammatory responses of M1 macrophages and promote M2 marker expression in vitro. Data indicated the possible involvement of Jak2/STAT3/STAT6 pathway in the augmentation of EPO on M2 polarization. These results improved the understanding of the immunoregulatory capacity of EPO on macrophages, which might optimize the therapeutic modalities of EPO.
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Affiliation(s)
- Shuo Wang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Chao Zhang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Jiawei Li
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Sidikejiang Niyazi
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Long Zheng
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Ming Xu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Ruiming Rong
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China.,Department of Transfusion, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cheng Yang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Tongyu Zhu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China.,Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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14
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Yeon EK, Ryu KN, Kang HJ, Yoon SH, Park SY, Park JS, Jin W. Characteristic MR image finding of squatting exercise-induced rhabdomyolysis of the thigh muscles. Br J Radiol 2017; 90:20160740. [PMID: 28181821 DOI: 10.1259/bjr.20160740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To describe the characteristic MRI appearance of squatting-induced rhabdomyolysis involving the thigh muscles. METHODS This study consisted of 10 cases obtained at 3 institutions from 2005 to 2015. A retrospective review was performed to obtain clinical information and MR scans for rhabdomyolysis of the thigh muscles. MRI was analyzed according to the distribution and degree of muscle involvement; the degree was assessed and graded as normal, mild or prominent. RESULTS The mean patient age was 20.2 years (range, 15-24 years), and 7 of the 10 patients were male. All patients had history of excessive squatting action, suffered clinically from bilateral thigh pain and were confirmed to have rhabdomyolysis through analysis of serum creatine kinase (CK) levels. All of the patients (10/10) exhibited diffuse mild to prominent degree involvement of the anterior thigh muscles according to fluid-sensitive MR sequences. Among the anterior thigh muscles, the rectus femoris was spared in 8 patients (8/10) and mild degree involved in 2 patients (2/10). Thus, no cases exhibited prominent degree involvement of the rectus femoris muscle. CONCLUSION Preservation of the rectus femoris muscle on MRI in squatting-induced rhabdomyolysis may be useful for differentiating rhabdomyolysis from other aetiologies. Advances in knowledge: Preservation of rectus femoris on MRI is distinguishable finding in squatting-induced rhabdomyolysis and reflects the functional anatomy of anterior thigh muscles.
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Affiliation(s)
- Eung K Yeon
- 1 Department of Medicine, Graduate School, Kyung Hee University, Dongdaemun-ku, Seoul, Republic of Korea
| | - Kyung N Ryu
- 2 Department of Radiology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Dongdaemun-ku, Seoul, Republic of Korea
| | - Hye J Kang
- 2 Department of Radiology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Dongdaemun-ku, Seoul, Republic of Korea
| | - So H Yoon
- 4 Department of Radiology, National Police Hospital, Songpa-gu, Seoul, Republic of Korea
| | - So Y Park
- 3 Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Gangdong-gu, Seoul, Republic of Korea
| | - Ji S Park
- 2 Department of Radiology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Dongdaemun-ku, Seoul, Republic of Korea
| | - Wook Jin
- 3 Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Gangdong-gu, Seoul, Republic of Korea
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15
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Mécanismes et prise en charge de la tubulopathie liée à la rhabdomyolyse. MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-016-1229-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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17
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Satirapoj B, Kongthaworn S, Choovichian P, Supasyndh O. Electrolyte disturbances and risk factors of acute kidney injury patients receiving dialysis in exertional heat stroke. BMC Nephrol 2016; 17:55. [PMID: 27267762 PMCID: PMC4895821 DOI: 10.1186/s12882-016-0268-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 06/01/2016] [Indexed: 02/04/2023] Open
Abstract
Background Exertional heat stroke (EHS) is a life-threatening illness and leads to multi-organ dysfunction including acute kidney injury (AKI). The clinical significance of abnormal electrolytes and renal outcomes in ESH patients has been poorly documented. We aim to exhibit the electrolyte abnormalities, renal outcomes and risk factors of patients with AKI receiving dialysis in EHS. Methods A retrospective cohort study in EHS patients between 2003 and 2014 were conducted. Clinical and laboratory outcomes including serum and urine electrolytes, AKI and dialysis were assessed on admission, during hospitalization and at the time of their discharge from the hospital. A logistic regression analysis was performed for risk factors of acute dialysis. Results All 66 subjects with mean age 22.1 ± 4.3 years were included. On admission, the common electrolyte disturbances were hypokalemia (71.2 %), hypophosphatemia (59.1 %), hyponatremia (53.0 %), hypocalcemia (51.5 %), and hypomagnesemia (34.9 %). Electrolytes depletion was confirmed as renal loss (potassium loss; 54.2 %, phosphate loss; 86.7 %, sodium loss; 64.7 % and magnesium loss; 83.3 %). During hospitalization ranging from 2 to 209 days, 90.9 % patients suffered from AKI with 16.7 % receiving acute dialysis, and 3 % patients died. At discharge, AKI and electrolyte abnormalities had dramatically improved. The prognosis factors for AKI receiving dialysis were identified as neurological status, renal function and serum muscle enzyme at time of admission. Conclusion The study suggests that hypoelectrolytemia and AKI are frequently observed in patients with EHS. Neurological impairment, impaired renal function, and increased serum muscle enzyme should be considered risk factors of acute dialysis.
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Affiliation(s)
- Bancha Satirapoj
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, 315, Bangkok, 10400, Thailand.
| | - Suramanat Kongthaworn
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, 315, Bangkok, 10400, Thailand
| | - Panbubpa Choovichian
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, 315, Bangkok, 10400, Thailand
| | - Ouppatham Supasyndh
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, 315, Bangkok, 10400, Thailand
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18
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Postoperative rhabdomyolysis following robotic renal and adrenal surgery: a cautionary tale of compounding risk factors. J Robot Surg 2015; 9:195-200. [DOI: 10.1007/s11701-015-0515-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 06/02/2015] [Indexed: 11/26/2022]
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19
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High Risk of Rhabdomyolysis and Acute Kidney Injury After Traumatic Limb Compartment Syndrome. Ann Plast Surg 2015; 74 Suppl 2:S158-61. [DOI: 10.1097/sap.0000000000000460] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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20
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Fan H, Zhao Y, Zhu JH, Song FC, Ye JH, Wang ZY, Le JW. Thrombocytopenia as a predictor of severe acute kidney injury in patients with heat stroke. Ren Fail 2015; 37:877-81. [PMID: 25774629 DOI: 10.3109/0886022x.2015.1022851] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Abnormalities of blood system often occur several days before acute kidney injury (AKI) in patients with heat stroke (HS). We aimed to investigate the prevalence and prognostic value of the early hematological markers in patients with AKI induced by HS. METHODS In a retrospective cohort study, we analyzed the case records of 176 patients with HS and evaluated the hematological markers for early prediction and risk classification in the patients with AKI. RESULTS Of 176, 103 (58%) HS cases developed AKI, and men comprised more than half (75%) of the sample population. The nadir platelet count significantly correlated with the levels of peak serum creatinine (r = -0.608, p < 0.01) and blood urea nitrogen (r = -0.546, p < 0.01), and the length of hospital stay (r = -0.393, p < 0.01). The areas under the receiver operating characteristic curves (AU-ROC) indicated the prognostic accuracy of hematological markers, AU-ROC was significantly higher with the nadir platelet count than that with the admission platelet count (AU-ROC of the nadir platelet: 0.73; 95% CI: 0.67-0.82; vs. AU-ROC of the admission platelet: 0.67; 95% CI: 0.59-0.75; p < 0.01). Multiple logistic regression results indicated that the nadir platelet count (adjusted ORs: 37.92; 95% CI: 2.18-87.21; p < 0.01) was independent predictor of AKI in HS. CONCLUSION The high mortality observed in HS complicated with AKI, and among the various hematological parameters assessed, thrombocytopenia is associated with AKI induced by HS independently.
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Affiliation(s)
- Heng Fan
- a Department of Intensive Care Unit , Ningbo First Hospital , Ningbo , China
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21
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The definition of acute kidney injury and its use in practice. Kidney Int 2014; 87:62-73. [PMID: 25317932 DOI: 10.1038/ki.2014.328] [Citation(s) in RCA: 437] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 02/24/2014] [Accepted: 02/27/2014] [Indexed: 01/04/2023]
Abstract
Acute kidney injury (AKI) is a common syndrome that is independently associated with increased mortality. A standardized definition is important to facilitate clinical care and research. The definition of AKI has evolved rapidly since 2004, with the introduction of the Risk, Injury, Failure, Loss, and End-stage renal disease (RIFLE), AKI Network (AKIN), and Kidney Disease Improving Global Outcomes (KDIGO) classifications. RIFLE was modified for pediatric use (pRIFLE). They were developed using both evidence and consensus. Small rises in serum creatinine are independently associated with increased mortality, and hence are incorporated into the current definition of AKI. The recent definition from the international KDIGO guideline merged RIFLE and AKIN. Systematic review has found that these definitions do not differ significantly in their performance. Health-care staff caring for children or adults should use standard criteria for AKI, such as the pRIFLE or KDIGO definitions, respectively. These efforts to standardize AKI definition are a substantial advance, although areas of uncertainty remain. The new definitions have enabled the use of electronic alerts to warn clinicians of possible AKI. Novel biomarkers may further refine the definition of AKI, but their use will need to produce tangible improvements in outcomes and cost effectiveness. Further developments in AKI definitions should be informed by research into their practical application across health-care providers. This review will discuss the definition of AKI and its use in practice for clinicians and laboratory scientists.
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22
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Klainbart S, Ranen E, Glikman G, Kelmer E, Bdolah-Abram T, Aroch I. Hindlimb lameness and gait abnormalities in bitches with pyometra. Vet Rec 2014; 175:46. [PMID: 24789856 DOI: 10.1136/vr.102376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The objective of this study was to assess the frequency of gait abnormalities and lameness (GAL) in bitches with pyometra, and their association with clinical and laboratory findings. The study included 79 bitches diagnosed with pyometra and 35 negative control intact bitches presented with other soft tissue surgical disorders. Dogs with a history of chronic lameness due to orthopaedic or neurological origin were excluded. A history of GAL was more frequent in the pyometra group (47 per cent) compared with the control group (20 per cent) (P=0.007). In the pyometra group, bitches presenting GAL had (P<0.04) higher frequencies of closed-cervix pyometra, anorexia and vomiting, as well as higher serum creatinine concentration and muscle enzymes activity, compared with those in without GAL. GAL signs resolved postovariohysterectomy in all but one bitch. The results suggest that GAL signs occur frequently in bitches with pyometra, especially in closed-cervix disease. Therefore, pyometra should be considered among the differential diagnoses when GAL occurs, especially when the clinical signs are non-specific and the reproductive history is unclear.
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Affiliation(s)
- S Klainbart
- Hebrew University Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot 761001, Israel
| | - E Ranen
- Hebrew University Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot 761001, Israel
| | - G Glikman
- Hebrew University Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot 761001, Israel 5/1 HaArugot St. Pardes-Hana 37082, Israel
| | - E Kelmer
- Hebrew University Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot 761001, Israel
| | - T Bdolah-Abram
- Hebrew University Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot 761001, Israel
| | - I Aroch
- Hebrew University Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot 761001, Israel
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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: 225] [Impact Index Per Article: 22.5] [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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Gupta P, Sharma A, Khullar D. Myoglobinuria masquerading as acute rejection in a renal allograft recipient with recurrent post transplant diabetic nephropathy. Ren Fail 2014; 36:1133-5. [PMID: 24826952 DOI: 10.3109/0886022x.2014.918830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Rhabdomyolysis contributes to 7-10% of total AKI cases. Myoglobinuria as a cause of acute renal allograft dysfunction is extremely uncommon. Renal allograft recipient on cyclosporine or tacrolimus can develop myoglobinuria in presence of other precipitating factors. Present case describes an interesting report of myoglobinuria in a patient with post transplant diabetic nephropathy mimicking acute graft rejection. Clinically myoglobinuria presenting as renal allograft dysfunction is diagnosis of exclusion and renal biopsy is extremely important in making a correct diagnosis and planning optimal management in such cases.
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Wu B, Gong D, Ji D, Xu B, Liu Z. Clearance of myoglobin by high cutoff continuous veno-venous hemodialysis in a patient with rhabdomyolysis: a case report. Hemodial Int 2014; 19:135-40. [PMID: 24766332 DOI: 10.1111/hdi.12172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Continuous veno-venous hemodialysis using high cutoff filters (HCO-CVVHD) is a promising technique, which may be effective to decrease the extremely high level of circulating myoglobin in patients with rhabdomyolysis (RM). Here, we report a patient with RM caused by heat stroke who was successfully treated by HCO-CVVHD. A male patient received HCO-CVVHD with 4 L/h dialysate for 5 days and then pre-dilution continuous veno-venous hemofiltration (CVVH) at a dose of 4 L/h until recovery of renal function. The clearance of myoglobin and albumin at 5 minutes, and at 4, 12, and 24 hours were calculated. The serum myoglobin level decreased from a peak of 25,400 ng/mL on admission to 133 ng/mL at discharge. During HCO-CVVHD, the mean clearances of serum myoglobin at four timepoints were 61.3 (range, 61.0-61.6), 52.3 (38.9-65.8), 47.3 (46.8-47.9), and 43.7 (39.5-48.0) mL/min, respectively, and the mean clearances of albumin were 12.4 (range, 11.8-13.1), 3.1 (2.5-3.8), 1.2 (1.0-1.4), and 0.8 (0.6-1.0) mL/min, respectively. During CVVH, the clearance rates of myoglobin at 5 minutes and 24 hours were 17.0 and 3.8 mL/min, respectively, with a negligible clearance of albumin. HCO-CVVHD can effectively decrease serum myoglobin in patients with RM because of much higher clearance of myoglobin than CVVH. However, attention should be paid to albumin loss during HCO-CVVHD.
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Affiliation(s)
- Buyun Wu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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Rodríguez E, Soler MJ, Rap O, Barrios C, Orfila MA, Pascual J. Risk factors for acute kidney injury in severe rhabdomyolysis. PLoS One 2013; 8:e82992. [PMID: 24367578 PMCID: PMC3867454 DOI: 10.1371/journal.pone.0082992] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 11/08/2013] [Indexed: 01/06/2023] Open
Abstract
Background Acute kidney injury (AKI) is a life-threatening complication of severe rhabdomyolysis. This study was conducted to assess risk factors for AKI and to develop a risk score for early prediction. Methods Retrospective observational cohort study with a 9-year follow-up, carried out in an acute-care teaching-affiliated hospital. A total of 126 patients with severe rhabdomyolysis defined as serum creatine kinase (CK) > 5,000 IU/L fulfilled the inclusion criteria. Univariate and logistic regression analyses were performed to determine risk factors for AKI. Based on the values obtained for each variable, a risk score and prognostic probabilities were estimated to establish the risk for developing AKI. Results The incidence of AKI was 58%. Death during hospitalization was significantly higher among patients with AKI, compared to patients without AKI (19.2% vs 3.6%, p = 0.008). The following variables were independently associated with AKI: peak CK (odds ratio [OR] 4.9, 95%CI 1.4-16.8), hypoalbuminemia (< 33 mg/dL, [OR 5.1, 95%CI 1.4-17-7]), metabolic acidosis (OR 5.3, 95%CI 1.4-20.3), and decreased prothrombin time (OR 4.4, 95% CI 1.3-14.5). A risk score for AKI was calculated for each patient, with an OR of 1.72 (95%CI 1.45-2.04). The discrimination value of the predictive model was established by means of a ROC curve, with the area under the curve of 0.871 (p<0.001). Conclusions The identification of independent factors associated with AKI and a risk score for early prediction of this complication in patients with severe rhabdomyolysis may be useful in clinical practice, particularly to implement early preventive measures.
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Affiliation(s)
- Eva Rodríguez
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
- Nephrology Research Group, Institut Mar d’Investigacions Mediques, Barcelona, Spain
- * E-mail:
| | - María J. Soler
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
- Nephrology Research Group, Institut Mar d’Investigacions Mediques, Barcelona, Spain
| | - Oana Rap
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Clara Barrios
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
- Nephrology Research Group, Institut Mar d’Investigacions Mediques, Barcelona, Spain
| | - María A. Orfila
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
- Nephrology Research Group, Institut Mar d’Investigacions Mediques, Barcelona, Spain
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Abstract
IMPORTANCE Rhabdomyolysis ranges in severity from asymptomatic elevations in creatine phosphokinase levels to a life-threatening disorder characterized by severe acute kidney injury requiring hemodialysis or continuous renal replacement therapy (RRT). OBJECTIVE To develop a risk prediction tool to identify patients at greatest risk of RRT or in-hospital mortality. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 2371 patients admitted between January 1, 2000, and March 31, 2011, to 2 large teaching hospitals in Boston, Massachusetts, with creatine phosphokinase levels in excess of 5000 U/L within 3 days of admission. The derivation cohort consisted of 1397 patients from Massachusetts General Hospital, and the validation cohort comprised 974 patients from Brigham and Women's Hospital. MAIN OUTCOMES AND MEASURES The composite of RRT or in-hospital mortality. RESULTS The causes and outcomes of rhabdomyolysis were similar between the derivation and validation cohorts. In total, the composite outcome occurred in 19.0% of patients (8.0% required RRT and 14.1% died during hospitalization). The highest rates of the composite outcome were from compartment syndrome (41.2%), sepsis (39.3%), and following cardiac arrest (58.5%). The lowest rates were from myositis (1.7%), exercise (3.2%), and seizures (6.0%). The independent predictors of the composite outcome were age, female sex, cause of rhabdomyolysis, and values of initial creatinine, creatine phosphokinase, phosphate, calcium, and bicarbonate. We developed a risk-prediction score from these variables in the derivation cohort and subsequently applied it in the validation cohort. The C statistic for the prediction model was 0.82 (95% CI, 0.80-0.85) in the derivation cohort and 0.83 (0.80-0.86) in the validation cohort. The Hosmer-Lemeshow P values were .14 and .28, respectively. In the validation cohort, among the patients with the lowest risk score (<5), 2.3% died or needed RRT. Among the patients with the highest risk score (>10), 61.2% died or needed RRT. CONCLUSIONS AND RELEVANCE Outcomes from rhabdomyolysis vary widely depending on the clinical context. The risk of RRT or in-hospital mortality in patients with rhabdomyolysis can be estimated using commonly available demographic, clinical, and laboratory variables on admission.
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Affiliation(s)
- Gearoid M McMahon
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts2Framingham Heart Study, National Heart, Lung, and Blood Institute, and Center for Population Studies, Framingham, Massachusetts
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Heyne N, Guthoff M, Krieger J, Haap M, Häring HU. High cut-off renal replacement therapy for removal of myoglobin in severe rhabdomyolysis and acute kidney injury: a case series. Nephron Clin Pract 2013; 121:c159-64. [PMID: 23327834 DOI: 10.1159/000343564] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 08/31/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM Rhabdomyolysis is associated with the release of myoglobin into the circulation, promoting acute kidney injury (AKI). In severe rhabdomyolysis, dialysis-dependent AKI doubles mortality. Standard blood purification techniques have limited efficacy in removing myoglobin. We describe high cut-off (HCO) renal replacement therapy (RRT) as a novel approach for extracorporeal elimination of myoglobin in rhabdomyolysis-associated AKI. METHODS With an in vivo molecular cut-off at 45 kDa, HCO filters are effective in removing myoglobin (17.8 kDa). Clearances across standard and HCO filters using continuous or intermittent RRT are reviewed in a case series of 11 patients with severe rhabdomyolysis and dialysis-dependent AKI. RESULTS Median myoglobin clearance across standard high-flux filters was 3.3 (interquartile range 2.3-3.9) ml/min for sustained low-efficiency daily dialysis (SLEDD) batch hemodialysis (HD) and 3.7 (2.9-6.7) ml/min for conventional HD. Respective clearances using HCO filters (membrane surface area: 1.1 m(2)) were 21.7 (20.3-26.1) ml/min (SLEDD) and 44.2 (41.3-47.0) ml/min (HD). Corrected for filter size, up to 20-fold higher clearances were obtained using HCO filters, resulting in profound and sustained reduction of plasma myoglobin concentration. CONCLUSIONS As a novel approach, HCO RRT allows for rapid and effective removal of myoglobin from the circulation. In light of the pathogenic role in AKI, reducing exposure of the kidney to myoglobin may improve renal recovery and patient outcome. Our data pave the way for prospective trials, addressing this issue.
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Affiliation(s)
- Nils Heyne
- Department of Endocrinology and Diabetology, Angiology, Nephrology and Clinical Chemistry, University of Tübingen, Tübingen, Germany.
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Longo DL, Busato A, Lanzardo S, Antico F, Aime S. Imaging the pH evolution of an acute kidney injury model by means of iopamidol, a MRI-CEST pH-responsive contrast agent. Magn Reson Med 2012; 70:859-64. [DOI: 10.1002/mrm.24513] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 08/10/2012] [Accepted: 09/10/2012] [Indexed: 12/28/2022]
Affiliation(s)
- Dario Livio Longo
- Department of Chemistry and Molecular Imaging Center; University of Turin; Torino Italy
| | - Alice Busato
- Department of Chemistry and Molecular Imaging Center; University of Turin; Torino Italy
| | - Stefania Lanzardo
- Department of Clinical and Biological Science; University of Turin; Torino Italy
| | - Federica Antico
- Department of Internal Medicine; University of Turin; Torino Italy
| | - Silvio Aime
- Department of Chemistry and Molecular Imaging Center; University of Turin; Torino Italy
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Rhabdomyolysis and Acute Kidney Injury due to Severe Heat Stroke. Case Rep Crit Care 2011; 2011:951719. [PMID: 24826326 PMCID: PMC4010049 DOI: 10.1155/2011/951719] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 09/18/2011] [Indexed: 01/06/2023] Open
Abstract
We present a case of heat stroke (HS) and acute kidney injury (AKI) due to severe rhabdomyolysis in a 14-year-old previously healthy female patient. When she was practicing strenuous exercise she suffered acute seizures and high fever. These symptoms were followed by coma and multiple organ failure (MOF), which included AKI, encephalopathy, fulminant hepatic failure (FHF), and disseminated intravascular coagulation (DIC). The patient was managed in the ICU with renal replacement therapy, ventilatory support, and other vital supporting measures. After three weeks of ICU treatment she made a full recovery.
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Herráez García J, Torracchi Carrasco AM, Antolí-Royo AC, de la Fuente Blanco R, Santos Jiménez MT. [Rhabdomyolysis. A descriptive study of 449 patients]. Med Clin (Barc) 2011; 139:238-42. [PMID: 21939988 DOI: 10.1016/j.medcli.2011.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 05/28/2011] [Accepted: 05/31/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Rhabdomyolysis is a clinical syndrome characterized by acute necrosis of skeletal muscles along with the release of breakdown products into the bloodstream. Rhabdomyolysis is potentially lethal and its most serious complication is acute renal failure (ARF). Diagnosis is established by the 5-times elevation (975 UI/l) over the upper limit of creatine-kinase (CK). PATIENTS AND METHODS We performed a retrospective study on Salamanca University Hospital for the period 1999-2010. There were 449 patients diagnosed with rhabdomyolysis over which we tested demographic, etiologic, analytic, complication and mortality variables. RESULTS Out of 449 patients, 69% were male. Average age was 66.5 ± 21 years. Most frequent etiologies were trauma, sepsis and immobility/crushing (24, 19 and 17% respectively). Maximum levels of CK were 343,170 ng/ml and its increase did not show significant association with mortality or ARF. This was found in 54% of patients (mean creatinine 3.03 mg/dl) and it was significantly associated with mortality (P <. 001). Global mortality was 18.7%. There were no significant associations between mortality and unique or multiple causes. However, there were significant associations between mortality and age (P <. 001) and 90% of deaths occurred among patients over 60 years old. CONCLUSION Rhabdomyolysis prevails in elder males. Trauma, sepsis and immobility/crushing are the most frequent etiologies. CK values are not related with ARF or mortality. Mortality is associated with most frequent causes, old age and ARF.
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Abstract
Rhabdomyolysis is a clinical syndrome defined by muscle breakdown and subsequent release of intracellular contents. There are many etiologies of rhabdomyolysis, classified here as congenital and acquired; compartment syndrome secondary to trauma with reperfusion injury is one common precipitating factor. Regardless of the underlying etiology, the pathophysiology follows a similar pathway via myocyte destruction and release of myoglobin into the systemic circulation. Rhabdomyolysis-induced renal failure is caused by the precipitation of myoglobin in the renal tubules which is enhanced under acidic conditions. A high index of clinical suspicion is required to promptly recognize rhabdomyolysis, especially in the unconscious patient. Presenting symptoms include tea-colored urine and muscle weakness or fatigue. The diagnosis is confirmed most reliably with the finding of elevated serum creatine kinase levels. Early, aggressive resuscitation with either normal saline or lactated Ringer's solution to maintain an adequate urine output is the most important intervention in preventing the development of acute renal failure. There is insufficient clinical evidence supporting the routine administration of diuretics and bicarbonate to protect against the development of acute renal failure.
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Affiliation(s)
- Mark L Shapiro
- Duke University Medical Center, Division of Trauma and Surgical Critical Care, Durham, NC, USA
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de Abreu KLS, Silva Júnior GB, Barreto AGC, Melo FM, Oliveira BB, Mota RMS, Rocha NA, Silva SL, Araújo SMHA, Daher EF. Acute kidney injury after trauma: Prevalence, clinical characteristics and RIFLE classification. Indian J Crit Care Med 2010; 14:121-8. [PMID: 21253345 PMCID: PMC3021827 DOI: 10.4103/0972-5229.74170] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is an uncommon but serious complication after trauma. The objective of this study was to evaluate the prevalence, clinical characteristics and outcome of AKI after trauma. PATIENTS AND METHODS This was a retrospective study performed from January 2006 to January 2008 in an emergency specialized hospital in Fortaleza city, northeast of Brazil. All patients with AKI admitted in the study period were included. Prevalence of AKI, clinical characteristics and outcome were investigated. RESULTS Of the 129 patients admitted to the intensive care unit (ICU), 52 had AKI. The mean age was 30.1 ± 19.2 years, and 79.8% were males. The main causes of AKI were sepsis in 27 cases (52%) and hypotension in 18 (34%). Oliguria was observed in 33 cases (63%). Dialysis was required for 19 patients (36.5%). Independent risk factors associated with AKI were abdominal trauma [odds ratio (OR) = 3.66, P = 0.027] and use of furosemide (OR = 4.10, P = 0.026). Patients were classified according to RIFLE criteria as Risk in 12 cases (23%), Injury in 13 (25%), Failure in 24 (46%), Loss in 1 (2%) and End-stage in 2 (4%). Overall in-hospital mortality was 95.3%. The main cause of death was sepsis (24%). Mortality was 100% among patients with AKI. CONCLUSIONS AKI is a fatal complication after trauma, which presented with a high mortality in the studied population. A better comprehension of factors associated with death in trauma-associated AKI is important, and more effective measures of prevention and treatment of AKI in this population are urgently needed.
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Affiliation(s)
- Krasnalhia Lívia S. de Abreu
- From:Division of Nephrology, Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Ceará, Brazil
| | - Geraldo B. Silva Júnior
- From:Division of Nephrology, Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Ceará, Brazil
| | - Adller G. C. Barreto
- From:Division of Nephrology, Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Ceará, Brazil
| | - Fernanda M. Melo
- From:Division of Nephrology, Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Ceará, Brazil
| | - Bárbara B. Oliveira
- From:Division of Nephrology, Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Ceará, Brazil
| | - Rosa M. S. Mota
- Department of Statistics, Science Center, Federal University of Ceará – UFC, Ceará, Brazil
| | - Natália A. Rocha
- From:Division of Nephrology, Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Ceará, Brazil
| | - Sônia L. Silva
- From:Division of Nephrology, Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Ceará, Brazil
- Department of Internal Medicine, School of Medicine, University of Fortaleza – UNIFOR, Fortaleza, Ceará, Brazil
| | - Sônia M. H. A. Araújo
- From:Division of Nephrology, Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Ceará, Brazil
| | - Elizabeth F. Daher
- From:Division of Nephrology, Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Ceará, Brazil
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Wang YM, Zhang Y, Ye ZB. Rhabdomyolysis Following Recent Severe Coxsackie Virus Infection in Patient with Chronic Renal Failure: One Case Report and a Review of the Literature. Ren Fail 2009; 28:89-93. [PMID: 16526325 DOI: 10.1080/08860220500461310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Coxsackie virus infection may be life-threatening, although in most cases, it is asymptomatic. Coxsackie virus infection can cause rhabdomyolysis. This study reports a 39-year-old female patient with chronic renal failure who presented with fever, myalgia, anuria, edema, vomiting, diarrhea, exacerbation of renal function, elevation of serum CK, CK-MB, CK-MM, myoglobin, and liver function abnormality. Serology for Coxsackie virus IgM antibody was positive at first, and IgG antibody became positive 4 weeks later. Muscle biopsy showed skeletal muscle denaturalization and necrosis. She underwent hemodialysis three times per week and then kidney transplantation. No evidence suggests relapse of Coxsackie virus infection 5 months after transplantation. As illustrated with the present case, serological testing may reveal an early, quick, and simple diagnosis in a case of rhabdomyolysis after a viral illness.
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Affiliation(s)
- Yi-Mei Wang
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
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36
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Affiliation(s)
- Xavier Bosch
- Muscle Research Unit, Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
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Chatzizisis YS, Misirli G, Hatzitolios AI, Giannoglou GD. The syndrome of rhabdomyolysis: complications and treatment. Eur J Intern Med 2008; 19:568-74. [PMID: 19046720 DOI: 10.1016/j.ejim.2007.06.037] [Citation(s) in RCA: 168] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Accepted: 06/21/2007] [Indexed: 12/18/2022]
Abstract
Rhabdomyolysis is a syndrome of skeletal muscle cell damage that leads to the release of toxic intracellular material into the systemic circulation. The pathogenesis of rhabdomyolysis is based on an increase in free ionized calcium in the cytoplasm. Its main complications include (a) acute renal failure, which is triggered by renal vasoconstriction and ischemia, (b) myoglobin cast formation in the distal convoluted tubules, and (c) direct renal toxic effect of myoglobin on the epithelial cells of proximal convoluted tubules. Other major complications include electrolyte disorders, such as hyperkalemia, which may cause cardiac arrhythmias, metabolic acidosis, hyperphosphatemia, early hypocalcemia, and late hypercalcemia. Compartmental syndrome and disseminated intravascular coagulopathy may also emerge. The management of myoglobinuric acute renal failure includes aggressive fluid administration to restore the hypovolemia and urine alkalization. The concomitant electrolyte and metabolic disorders should also be treated appropriately; hemodialysis should be considered when life-threatening hyperkalemia and metabolic acidosis exist. In the case of compartmental syndrome, it is important to monitor the intra-compartmental pressure and to perform fasciotomy, if required. When diagnosed early and if the appropriate treatment is initiated promptly, the complications of rhabdomyolysis are preventable and the syndrome has a good prognosis.
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Affiliation(s)
- Yiannis S Chatzizisis
- AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece
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Chang CC, Chang YC, Chang ST, Chang WK, Chang HY, Chen LC, Chu HY, Lai MH, Hsieh MF, Tsai KC. Efficacy of near-infrared irradiation on intractable hiccup in custom-set acupoints: evidence-based analysis of treatment outcome and associated factors. Scand J Gastroenterol 2008; 43:538-44. [PMID: 18415745 DOI: 10.1080/00365520701843019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The condition intractable hiccup (IH) is generally an incapacitating disorder indicating neurologic or non-neurologic disorders. Linearly polarized, near-infrared irradiation (SL) is shown to be effective in the treatment of IH where it is applied on custom-set acupoints. The aim of this study was to investigate the treatment efficacy of IH by SL on the acupoints and to survey the relationship between IH and comorbid-related factors. MATERIAL AND METHODS. A total of 35 patients with IH were enrolled prospectively and divided into central and non-central groups. All patients received SL using an SG-type lens unit on the relevant acupoints and were followed-up for up to 6 months for efficacy of the novel therapy. RESULTS There was no significant difference between patients with IH produced by central or non-central origins (p=0.7105) regarding the therapeutic effect of SL; however, the effects of age, bed-shaking, gun-waving motion and nasogastric (NG)-tube placement were significant. The severity index of IH was analyzed and found to be associated with the seasons. For those patients with elevated levels of aspartate aminotransferase (ASAT) after therapy, it took a significantly shorter (p=0.0029) period of time to treat IH with this novel therapy (p=0.0029). Thirty-four patients had complete resolution of IH within a few days of beginning SL, with partial resolution in 1 patient only. CONCLUSIONS Without potential side effects, SL on custom-set acupoints could be a complementary therapy for patients with IH regardless of central or non-central origins.
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Affiliation(s)
- Cheng-Chiang Chang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
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39
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Abstract
Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle causing myoglobin and other intracellular proteins and electrolytes to leak into the circulation. The development of rhabdomyolysis is associated with a wide variety of diseases, injuries, medications and toxins. While the exact mechanisms responsible for all the causes are not fully understood, it is clear that muscle damage can occur from direct injury or by metabolic inequalities between energy consumption and energy production. Rhabdomyolysis is diagnosed by elevations in serum creatine phosphokinase (CPK), and while there is no established serum level cut-off, many clinicians use five times the upper limit of normal ( approximately 1000 U/l). Rhabdomyolysis can be complicated by acute renal failure (occurring in 4%-33% of patients), compartment syndrome, cardiac dysrhythmias via electrolyte abnormalities, and disseminated intravascular coagulopathy. The mainstay of treatment is hospitalisation with aggressive intravenous fluid (IVF) resuscitation with the correction/prevention of electrolyte abnormalities. There are additional adjunctive therapies to IVF, such as alkalinisation of the urine with sodium bicarbonate, diuretic therapy or combinations of both; however the lack of large randomised control studies concerning the benefits of these treatments makes it difficult to make strong recommendations for or against their use in the treatment of rhabdomyolysis. Regardless of these controversies, the overall prognosis for rhabdomyolysis is favourable when treated with early and aggressive IVF resuscitation, and full recovery of renal function is common. Irrespective of the cause of rhabdomyolysis the mortality rate may still be as high as 8%. This is a comprehensive review of the pathophysiology, diagnosis, complications and treatment options for rhabdomyolysis.
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Affiliation(s)
- W H Bagley
- Department of Emergency Medicine, St. Luke's-Roosevelt Hospital, University Hospital of Columbia Physicians & Surgeons, New York, NY 10025, USA
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40
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Lu CH, Tsang YM, Yu CW, Wu MZ, Hsu CY, Shih TTF. Rhabdomyolysis: magnetic resonance imaging and computed tomography findings. J Comput Assist Tomogr 2007; 31:368-74. [PMID: 17538281 DOI: 10.1097/01.rct.0000250115.10457.e9] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Our purpose was to describe the magnetic resonance (MR) imaging and computed tomography (CT) findings in patients with rhabdomyolysis. METHODS The medical records and imaging studies of 10 patients (5 males, 5 females; age range, 14-60 years; mean age, 28.3 years) with rhabdomyolysis were retrospectively reviewed. Magnetic resonance imaging was available in 9 patients and CT in 2 patients. RESULTS Two distinct imaging types of rhabdomyolysis were observed. For type 1 rhabdomyolysis (n = 2), the affected muscles revealed homogeneously isointense to hyperintense on T1-weighted, homogeneously hyperintense on T2-weighted and short-tau inversion recovery (STIR) images, and homogeneously enhanced on contrast-enhanced MR images. For type 2 rhabdomyolysis (n = 8), the affected muscles revealed homogeneously or heterogeneously isointense to hyperintense on T1-weighted images, heterogeneously hyperintense on T2-weighted and STIR images, heterogeneously hypodense on CT images, and rim enhanced on contrast-enhanced MR and CT images with the presence of a specific presentation, named as the "stipple sign." CONCLUSIONS Rhabdomyolysis is a clinical and biochemical syndrome comprising 2 distinct imaging types. Homogeneous signal changes and enhancement in the affected muscles advocate type 1 rhabdomyolysis. The stipple sign is helpful in demonstrating the areas of myonecrosis in type 2 rhabdomyolysis and, together with clinical and laboratory presentations, in reaching the correct diagnosis.
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Affiliation(s)
- Chia-Hung Lu
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Watanabe N, Inaoka T, Shuke N, Takahashi K, Aburano T, Chisato N, Nochi H, Go K. Acute rhabdomyolysis of the soleus muscle induced by a lightning strike: magnetic resonance and scintigraphic findings. Skeletal Radiol 2007; 36:671-5. [PMID: 17522908 DOI: 10.1007/s00256-006-0247-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2006] [Accepted: 11/15/2006] [Indexed: 02/02/2023]
Abstract
Among natural disasters, a lightning strike is a rare but potentially life-threatening phenomenon. If victims survive a cardiac arrest due to instantaneous passage of an exceptionally high voltage electric charge through the whole body, they may be afflicted with various complications such as muscle necrosis resulting in acute renal failure. In this article, we report a case of a 54-year-old man with acute rhabdomyolysis of the left soleus muscle associated with a lightning strike. T2-weighted and short-tau inversion recovery MR images showed a high signal intensity in the left soleus muscle. A whole-body bone scintigram showed abnormal uptakes in the left soleus muscle and the dorsal aspect of the left foot. MR and scintigraphic evaluations were very useful in depicting the site and extent of muscle damage. Since the patient showed a surprisingly high level of serum creatine kinase, the added information was very valuable for determining the patient's management.
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Affiliation(s)
- Naofumi Watanabe
- Department of Radiology, Asahikawa Medical College, 2-1-1-1 Midorigaoka-Higashi, Asahikawa 078-8510, Japan.
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Kim JH, Goo MJ, Yeom JS, Park ES, Seo JH, Lim JY, Park CH, Woo HO, Youn HS. Clinical characteristics of acute renal failure of rhabdomyolysis in children. KOREAN JOURNAL OF PEDIATRICS 2007. [DOI: 10.3345/kjp.2007.50.3.277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jae Hui Kim
- Department of Pediatrics, College of Medicine, The Gyeongsang National University, Jinju, Korea
| | - Min Ji Goo
- Department of Pediatrics, College of Medicine, The Gyeongsang National University, Jinju, Korea
| | - Jung Sook Yeom
- Department of Pediatrics, College of Medicine, The Gyeongsang National University, Jinju, Korea
| | - Eun Sil Park
- Department of Pediatrics, College of Medicine, The Gyeongsang National University, Jinju, Korea
| | - Ji Hyun Seo
- Department of Pediatrics, College of Medicine, The Gyeongsang National University, Jinju, Korea
| | - Jae Young Lim
- Department of Pediatrics, College of Medicine, The Gyeongsang National University, Jinju, Korea
| | - Chan Hoo Park
- Department of Pediatrics, College of Medicine, The Gyeongsang National University, Jinju, Korea
| | - Hyang Ok Woo
- Department of Pediatrics, College of Medicine, The Gyeongsang National University, Jinju, Korea
| | - Hee Shang Youn
- Department of Pediatrics, College of Medicine, The Gyeongsang National University, Jinju, Korea
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Rehman J, Boglia J, Chughtai B, Sukkarieh T, Khan SA, Lewis R, Darras F, Wadhwa NK, Samadi DB, Waltzer WC. High Body Mass Index in Muscular Patients and Flank Position Are Risk Factors for Rhabdomyolysis: Case Report after Laparoscopic Live-Donor Nephrectomy. J Endourol 2006; 20:646-50. [PMID: 16999617 DOI: 10.1089/end.2006.20.646] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND PURPOSE Rhabdomyolysis is well known after traumatic crush injuries or ischemia involving muscles. Postoperatively, it most likely is secondary to surgical positioning and patient muscle mass. We report a case after laparoscopic live-donor nephrectomy. CASE REPORT A muscular 35-year-old man underwent elective left laparoscopic live-donor nephrectomy in a 70 degrees flank position with four ports. He was in the right-side lying position with hip flexion (flank position) for approximately 4 hours. A kidney bridge had been placed between the iliac crest and the rib cage. Postoperatively, the patient had light-pinkish urine and low urine output. There was marked induration of the buttocks and significant pedal and scrotal edema. With judicious use of alkalinization and diuretics, the patient did not require dialysis, and renal function returned to base level by postoperative day 20. The recipient of the kidney had a normal postoperative course. CONCLUSION Rhabdomyolysis is a syndrome of muscle necrosis and release of intracellular components into the circulation. Acute renal failure secondary to myoglobinuria is a common complication. We currently use little flexion of the table during donor nephrectomy and bring the table to a neutral position immediately after kidney retrieval. Postoperatively, one needs a high index of suspicion for rhabdomyolysis to avoid or at least promptly recognize this rare but potentially serious condition after any operation lasting >or=4 hours.
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Affiliation(s)
- Jamil Rehman
- Department of Urology, SUNY-Stony Brook University Health Sciences Center, School of Medicine, Stony Brook, New York 11794-8093, USA.
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Affiliation(s)
- Mehmet Sukru Sever
- Department of Internal Medicine, Istanbul School of Medicine, Istanbul, Turkey.
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Abstract
Despite the commonly accepted indications for hemodialysis and extracorporeal depuritive techniques, some clinicians have come to rely on blood purification for clinical states where the targeted substance for removal differs from uremic waste products. Over the last decade, a number of studies have emerged to help define the application of extracorporeal blood purification (ECBP) to these "nonuremic" indications. This review describes the application of extracorporeal blood purification in clinical states including sepsis, rhabdomyolysis, congestive heart failure, hepatic failure, tumor lysis syndrome, adult respiratory distress syndrome, intravenous contrast exposure, and lactic acidosis. Additional comments are provided to review existing literature on thermoregulation and osmoregulation, including acute brain injury.
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Affiliation(s)
- Andrew E Briglia
- Department of Medicine, Division of Nephrology, University of Maryland, Baltimore, Maryland 21201, USA.
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Toprak Ö, Üzüm A, Ersoy R, Cirit M. HYPOCALCEMIA INDUCED RHABDOMYOLYSIS AND ACUTE RENAL FAILURE AFTER THYROIDECTOMY: A CASE REPORT. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2005. [DOI: 10.29333/ejgm/82273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
The clinical syndrome of rhabdomyolysis is caused by injury of skeletal muscles, leading to the release of various intracellular muscle constituents. Rhabdomyolysis occurs frequently but is usually asymptomatic (i.e., lab abnormalities only). However, in more serious cases, severe electrolyte disorders and acute renal failure may occur, leading to life-threatening situations. Rhabdomyolysis can develop in any circumstances where energy demands in muscles exceed the available energy supplies; it accounts for between 2 and 5% of all cases of acute renal failure in the ICU. Frequent causes of severe rhabdomyolysis include crush injuries, prolonged immobilization, seizures, severe infections and drug toxicity. Factors contributing to the development of more severe clinical symptoms include hypovolemia, hyperthermia, electrolyte disorders and the presence of pre-existing (congenital) muscle disorders. The diagnosis is established by elevation of serum muscle enzymes and muscle constituents such as creatinine phosphokinase and myoglobin. Preventive measures include maintenance of normal or high intravascular volume and administration of diuretics (loop diuretics rather than mannitol) once hypervolemia/euvolemia have been achieved. Some evidence suggests that early initiation of renal replacement therapy can help improve outcome. Administration of bicarbonate to induce urinary alkalosis can be considered, but it has not been proven to be effective.
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Affiliation(s)
- K H Polderman
- Department of Intensive Care, VU University Medical Center, Amsterdam, The Netherlands.
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Abstract
Rhabdomyolysis is a postoperative complication that may result in acute renal failure owing to excessive myoglobinuria. After uncomplicated laparoscopic left transperitoneal donor nephrectomy, a 32-year-old man developed anuric acute renal failure secondary to postoperative rhabdomyolysis that required intermittent hemodialysis for 2 weeks. The presumed risk factors in this case were the patient's high body mass index, intraoperative flank position with flexion, a solitary kidney, and the duration of surgery. Our current surgical technique has been modified to drop the kidney bridge early, immediately after visualization of the hilum.
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Affiliation(s)
- Wayne Kuang
- Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Preedy VR, Adachi J, Ueno Y, Ahmed S, Mantle D, Mullatti N, Rajendram R, Peters TJ. Alcoholic skeletal muscle myopathy: definitions, features, contribution of neuropathy, impact and diagnosis. Eur J Neurol 2001; 8:677-87. [PMID: 11784353 DOI: 10.1046/j.1468-1331.2001.00303.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Alcohol misusers frequently have difficulties in gait, and various muscle symptoms such as cramps, local pain and reduced muscle mass. These symptoms are common in alcoholic patients and have previously been ascribed as neuropathological in origin. However, biochemical lesions and/or the presence of a defined myopathy occur in alcoholics as a direct consequence of alcohol misuse. The myopathy occurs independently of peripheral neuropathy, malnutrition and overt liver disease. Chronic alcoholic myopathy is characterized by selective atrophy of Type II fibres and the entire muscle mass may be reduced by up to 30%. This myopathy is arguably the most prevalent skeletal muscle disorder in the Western Hemisphere and occurs in approximately 50% of alcohol misusers. Alcohol and acetaldehyde are potent inhibitors of muscle protein synthesis, and both contractile and non-contractile proteins are affected by acute and chronic alcohol dosage. Muscle RNA is also reduced by mechanisms involving increased RNase activities. In general, muscle protease activities are either reduced or unaltered, although markers of muscle membrane damage are increased which may be related to injury by reactive oxygen species. This supposition is supported by the observation that in the UK, alpha-tocopherol status is poor in myopathic alcoholics. Reduced alpha-tocopherol may pre-dispose the muscle to metabolic injury. However, experimental alpha-tocopherol supplementation is ineffective in preventing ethanol-induced lesions in muscle as defined by reduced rates of protein synthesis and in Spanish alcoholics with myopathy, there is no evidence of impaired alpha-tocopherol status. In conclusion, by a complex series of mechanisms, alcohol adversely affects skeletal muscle. In addition to the mechanical changes to muscle, there are important metabolic consequences, by virtue of the fact that skeletal muscle is 40% of body mass and an important contributor to whole-body protein turnover.
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Affiliation(s)
- V R Preedy
- Department of Nutrition and Dietetics, King's College London, UK.
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Patel M. Re.: Acute noncontact compartment syndrome. J Orthop Trauma 2001; 15:378-9. [PMID: 11433148 DOI: 10.1097/00005131-200106000-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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