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Akar HT, Yıldız Y, Mutluay R, Tekin E, Tokatlı A. Adult-onset carnitine palmitoyl transferase II (CPT II) deficiency presenting with rhabdomyolysis and acute kidney injury. CEN Case Rep 2024; 13:81-85. [PMID: 37341884 PMCID: PMC10982194 DOI: 10.1007/s13730-023-00804-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 06/22/2023] Open
Abstract
Metabolic myopathies are among the treatable causes of rhabdomyolysis and myoglobinuria. Carnitine palmitoyl transferase 2 (CPT II) deficiency is one of the most common causes of recurrent myoglobinuria in adults. It is an inherited disorder of fatty acid oxidation pathway, commonly associated with elevated acylcarnitine levels. In this case report, we present a 49-year-old male patient who developed acute kidney injury after rhabdomyolysis and was thus diagnosed with CPT2 deficiency after his first episode of rhabdomyolysis. Inborn errors of metabolism should be kept in mind in patients with rhabdomyolysis. Acylcarnitine profile may be normal in CPT II deficiency, even during an acute attack, and molecular genetic diagnostics should be applied if there is high index of clinical suspicion.
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Affiliation(s)
- Halil Tuna Akar
- Department of Pediatrics, Pediatric Metabolism Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Yılmaz Yıldız
- Department of Pediatrics, Pediatric Metabolism Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Rüya Mutluay
- Department of Internal Medicine, Nephrology Unit, Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Emel Tekin
- Department of Pathology, Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Ayşegül Tokatlı
- Department of Pediatrics, Pediatric Metabolism Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Detomaso F, Pepe V, Partipilo F, Gernone G. [Carnitin-Palmitoyl Transferase type 2 deficiency: a rare cause of acute renal failure due to rhabdomyolysis]. G Ital Nefrol 2019; 36:36-2-2019-12. [PMID: 30983179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Fatty acid oxidation disorders are inborn errors of metabolism. One of the possible alterations involves the failure of the carnitin-based transport of long-chain fatty acids into the mitochondria, necessary for muscle metabolism in case of prolonged physical exertion. Three kinds of Carnitin-Palmitoyl Transferase type 2 (CPT2) deficiency have been described: a myopathic form, a severe infantile form and a neonatal form. The clinical picture is characterized by recurrent attacks of rhabdomyolysis, muscular pains and fatigue, secondary to a prolonged physical exercise and sometimes aggravated by intercurrent events. Rhabdomyolysis episodes are associated with a significant increase in creatine phosphokinase and myoglobinuria and may result in acute renal failure. Patients are usually asymptomatic during intercurrent periods. When acute renal failure from rhabdomyolysis arises after intense physical activity, it is therefore necessary to also investigate the presence of metabolic myopathies due to enzymatic deficiency.
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Affiliation(s)
- Francesco Detomaso
- UOSVD di Nefrologia e Dialisi ASL Bari. Sede Direzionale: Osp. "S. Maria degli Angeli" Putignano
| | - Vito Pepe
- UOSVD di Nefrologia e Dialisi ASL Bari. Sede Direzionale: Osp. "S. Maria degli Angeli" Putignano
| | - Francesca Partipilo
- UOSVD di Nefrologia e Dialisi ASL Bari. Sede Direzionale: Osp. "S. Maria degli Angeli" Putignano
| | - Giuseppe Gernone
- UOSVD di Nefrologia e Dialisi ASL Bari. Sede Direzionale: Osp. "S. Maria degli Angeli" Putignano
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Dissanayake PV, Muthukumarana TGW, Aslam WAM, Chaminda SAA, Munasinghe TS, Kularatne SAM. An unusual case of gross myoglobinuria in a child following Russell's viper (Daboia russelii) envenomation. Toxicon 2019; 157:77-79. [PMID: 30448288 DOI: 10.1016/j.toxicon.2018.11.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
Abstract
Overt myoglobinuria associated with myotoxicity is a classic feature of sea snake envenomation. Russell's viper bites usually result in coagulopathy, neurotoxicity and nephrotoxicity but rarely myotoxicity has been reported, especially in the Sri Lankan variety (Daboia russelii). All those studies have demonstrated mild degree myotoxicity with microscopic level myoglobinuria. We report what is probably the first case of gross myoglobinuria in a child following a Russell's viper bite with biochemical evidence of significant myotoxicity well beyond the levels that have been previously reported.
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Affiliation(s)
- P V Dissanayake
- Department of Pediatrics, Faculty of Medicine, University of Peradeniya, 20400, Sri Lanka.
| | | | - W A M Aslam
- Teaching Hospital, Peradeniya, 20400, Sri Lanka
| | | | - T S Munasinghe
- Faculty of Medicine, University of Peradeniya, 20400, Sri Lanka
| | - S A M Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, 20400, Sri Lanka
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Abstract
In this paper, renal involvement secondary to other medical complications of heroin addiction is discussed. We review 12 published studies totalling 102 heroin addicts with renal disease. Of these, in only 40 patients could other discernible causes of renal disease be excluded. The existence of 40 reported cases of renal disease from a population of more than half a million is insufficient data upon which to postulate the existence of a type of renal disease unique to heroin addicts.
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Musumeci O, Bruno C, Mongini T, Rodolico C, Aguennouz M, Barca E, Amati A, Cassandrini D, Serlenga L, Vita G, Toscano A. Clinical features and new molecular findings in muscle phosphofructokinase deficiency (GSD type VII). Neuromuscul Disord 2011; 22:325-30. [PMID: 22133655 DOI: 10.1016/j.nmd.2011.10.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 10/16/2011] [Accepted: 10/30/2011] [Indexed: 11/19/2022]
Abstract
Muscle phosphofructokinase (PFKM) deficiency, a rare disorder of glycogen metabolism also known as glycogen storage disease type VII (GSDVII), is characterized by exercise intolerance, myalgias, cramps and episodic myoglobinuria associated with compensated hemolytic anaemia and hyperuricemia. We studied five patients with PFKM deficiency coming from different Italian regions. All probands showed exercise intolerance, hyperCKemia, cramps and myoglobinuria. One patient had a mild hypertrophic cardiomyopathy. Biochemical studies revealed residual PFK activity ranging from 1 to 5%. Molecular genetic analysis identified four novel mutations in the PFKM gene. In our series of patients, clinical and laboratory features were similar in all but one patient, who had an unusual phenotype characterized by 25 ears disease history, high CK levels, hypertrophic cardiomyopathy with paroxysmal atrial fibrillation without fixed muscle weakness.
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Affiliation(s)
- Olimpia Musumeci
- Department of Neurosciences, Psychiatry and Anaesthesiology University of Messina, Italy.
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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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Wahren J, Linderholm H, Felig P. Amino acid metabolism in patients with a hereditary myopathy and paroxysmal myoglobinuria. Acta Med Scand 2009; 206:309-14. [PMID: 506803 DOI: 10.1111/j.0954-6820.1979.tb13516.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Fu CG. [Treatment for crush syndrome of extremities with antioxidants]. Zhongguo Gu Shang 2008; 21:109-110. [PMID: 19105470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To study the clinical therapeutic effect of antioxidants assistant treatment of extremities crush syndrome (CS)in order to find new therapy. METHODS Twenty-one male patients (aged from 24 to 48 years, mean 36 years) were treated with the next antioxidants in early stage: (1) 20% Mannitol 250 ml intravenous drip in 30 minutes (one time per 6 to 8 h). (2) Sodium aescinate 20 mg, Salvia Miltiorrhiza 20 ml were dissolved respectively in isotonic saline or 5% glucose 200 ml and dripped by intravenous drip (50 to 60 drips per minute). The drugs were used for 5 to 7 days (one time per day). Basifying urine, keeping the nagative liquid banlance and electrolyte banlance, preventing infection and hold out treatment were done. When the pressure of muscular osteofascial compartment was more than 30 mmHg, deep fasia was cut to decompress timely and the above-mentioned drugs were continuously applied for patients. RESULTS Myoglobin urine of 21 cases died out after 2 to 3 days, of them, 13 cases were performed to decompress. After open decompression, 2 cases suffered from amputation because of long time of ischemia, 2 cases took place slight dysfunction of lower limbs, one hand had ischemia muscular contracture in 1 case and one foot down-vertical in 1 case. After followed-up of 8 months to 1 year, according to the function standard, the result were excellent in 8 cases, good in 7 cases, fair in 2 cases, poor in 4 cases. The excellent and good rate was about 71.4% (15/21). CONCLUSION After extremities crushed for long time, application of antioxidents as early as possible can decrease significantly the incidence and invalidity rate of CS.
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Affiliation(s)
- Chang-Guo Fu
- Department of Orthopaedics, Coal General Hospital of Henan Province, Zhengzhou 450002, Henan, China
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Okafor VU, Akpa FN. Acute renal failure due to myoglobulinuria in a patient struck by lightning. Nephrology (Carlton) 2006; 11:478-9. [PMID: 17014566 DOI: 10.1111/j.1440-1797.2006.00671.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Thomusch O, Gerstenkorn C, Boehm J, Arldt T, Hopt U, Pisarski P. Successful transplantation of kidneys from a donor with myoglobinuric acute renal failure. Am J Transplant 2006; 6:2500-1. [PMID: 16827784 DOI: 10.1111/j.1600-6143.2006.01462.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The shortage of donor organs is reflected in the growing number of patients on the waiting list for kidney transplantation worldwide. It seems to be sensible to expand the scarce donor pool by the cautious use of extended donor criteria. Kidneys from a 21-year-old deceased donor road traffic accident victim who suffered acute renal failure (ARF) due to myolysis were transplanted. Both transplantations were successful after an initial period of delayed graft function. Therefore, kidneys from deceased donors with ARF should not be excluded for transplantation in general.
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Affiliation(s)
- O Thomusch
- Department of General and Visceral Surgery, Albert-Ludwig University, Freiburg, Germany.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Hashimoto Y, Katada R, Iihoshi S, Niwa J. [Acute renal failure following convulsion-induced myoglobinuria]. No To Shinkei 2006; 58:803-5. [PMID: 17052009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
A 75-year-old female with history of putamenal hemorrhage 8 years earlier was admitted to our hospital with generalized convulsion lasting 40 minutes. Convulsion responded quickly to intravenous administration of diazepam, but deep coma persisted thereafter. Although renal function had normalized before this episode, urinary output was immediately estimated to be limited. Drip-infusion of Ringer's solution and the combined administration of furosemide and mannitol were started. The laboratory values 6 hours after admission demonstrated extremely elevated GOT, GPT, CPK, BUN and Cr levels, suggesting rhabdomyolysis. Urinalysis confirmed myoglobinuria. Despite massive diuretic therapy, renal dysfunction did not improve and she died on hospital day 4. The treatment outcome was probably influenced by her general condition of dehydration and acidosis at admission, as well as muscle damage caused by convulsion. Myoglobinuria can induce life-threatening renal failure, and may be caused by convulsion.
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Affiliation(s)
- Yuji Hashimoto
- Department of Neurosurgery, Hakodate Municipal Hospital, 1-10-1 Minato-cho, Hakodate-city, Hokkaido 041-8680, Japan
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O'Donnell A, Weatherall DJ, Taylor AM, Reeder JC, Allen SJ. Muscle cell injury, haemolysis and dark urine in children with falciparum malaria in Papua New Guinea. Trans R Soc Trop Med Hyg 2006; 100:817-25. [PMID: 16527319 DOI: 10.1016/j.trstmh.2005.11.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Revised: 11/21/2005] [Accepted: 11/21/2005] [Indexed: 11/17/2022] Open
Abstract
During a prospective study of red cell variants and severe malaria in children, a surprising observation was the occurrence of dark urine. Children were grouped according to urine findings: 22 had dark urine that contained a haem protein (Group I), 93 had urine of normal colour that contained a haem protein (Group II) and 236 had normal urine (Group III). To investigate the cause of dark urine, haemolysis and muscle cell injury were assessed. Intravascular haemolysis was greater in Group I than in Groups II and III. However, anaemia was more severe in Group III and is likely to have resulted mainly from extravascular haemolysis. Median plasma myoglobin concentrations were greater in Groups I and II than Group III (P = 0.00060). Plasma myoglobin was greater in children with cerebral malaria, hyperlactataemia and those who died but was not associated with acidosis. Urine myoglobin was greater in Group I than Groups II and III (P = 0.00054). It is likely that both haemoglobin and myoglobin contributed to dark urine. The association between muscle cell injury and coma suggests sequestration of parasitized red cells as a common underlying pathology. In malaria, hyperlactataemia may result directly from breakdown of muscle protein as well as tissue hypoxia.
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Affiliation(s)
- A O'Donnell
- Weatherall Institute of Molecular Medicine, University of Oxford, The John Radcliffe Hospital, Headington, Oxford OX3 9DS, UK.
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Abstract
OBJECTIVE Cardiac troponin I (cTnI) is considered the most specific marker of cardiac muscle injury. We encountered several patients with rhabdomyolysis and elevated cTnI, although they did not otherwise have evidence of cardiac injury. We determined the prevalence of false-positive cTnI in emergency department (ED) patients with rhabdomyolysis. METHODS We conducted a retrospective cohort study of ED patients admitted with a diagnosis of rhabdomyolysis. Patients were included in the study if they had a serum creatine kinase (CK) of 1000 U/L or greater and at least one serum cTnI determination. Patients with positive cTnI were considered true positives if they had either electrocardiography (EKG) or echocardiography abnormalities; false positives if both the EKG and the echocardiography were considered normal; or indeterminate if they did not have both an EKG and an echocardiogram. The primary outcome of the study was the prevalence of false-positive cTnI. Secondary outcomes included risk stratification by cocaine use, myoglobinuria, and renal failure and correlation of peak CK and troponin levels. RESULTS One hundred nine patients were included in the final analysis; 55 (50%) patients had a positive cTnI. Of the 55 patients with positive cTnI, 32 (58%) were true positives, 18 (33%) were false positives, and 5 (9%) were indeterminate. The prevalence of false-positive cTnI was 17% (18/109, 95% confidence interval 0.10-0.25). There was no association between false-positive cTnI and cocaine use, renal failure, or myoglobinuria. There was poor correlation between peak CK and peak cTnI levels (r = -.08, 95% confidence interval -0.34 to 0.19). CONCLUSION The prevalence of false-positive cTnI in ED patients with rhabdomyolysis is 17%.
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Affiliation(s)
- Siu Fai Li
- Department of Emergency Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
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Kim HW, Choi JR, Jang SJ, Chang YS, Bang BK, Park CW. Recurrent rhabdomyolysis and myoglobinuric acute renal failure in a patient with polymyositis. Nephrol Dial Transplant 2005; 20:2255-8. [PMID: 15985512 DOI: 10.1093/ndt/gfh950] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hyung Wook Kim
- Division of Nephrology, Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea, 93 Chi-Dong, Paldal-Ku, Suwon 442-723 Korea
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Tolouian R, Wild D, Lashkari MH, Najafi I. Oral alkalinizing solution as a potential prophylaxis against myoglobinuric acute renal failure: preliminary data from healthy volunteers. Nephrol Dial Transplant 2005; 20:1228-31. [PMID: 15784638 DOI: 10.1093/ndt/gfh779] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Acute renal failure (ARF) secondary to crush injury is one of the leading causes of hospitalization and death in survivors of massive disasters. The standard therapy for crush injury, intravenous (i.v.) hydration and alkalinization of urine, is often not feasible after a mass disaster; therefore, oral rehydration and urinary alkalinization may be a useful substitute. METHODS We developed and evaluated an oral alkalinizing solution (OAS) to induce alkaline diuresis. We enrolled 12 volunteer Iranian Army recruits (mean age 19.4+/-0.8 years) who drank an average of 650 ml of OAS for 12 h. We checked the volume and pH of their urine every hour, and measured venous blood gas and electrolytes at 6, 12 and 15 h. RESULTS All subjects tolerated the OAS without adverse events, and had active diuresis (>200 ml/h) after an average of 3.0+/-0.7 h. Their urine became alkaline (pH>7.0) within an average of 3.25+/-0.8 h. There were no significant electrolyte abnormalities. CONCLUSIONS OAS seems to be a safe and promising means of inducing alkaline diuresis. It may be a feasible alternative to i.v. hydration to prevent ARF secondary to crush injuries in the context of mass disasters where i.v. hydration is not possible. A dose of 10 ml/kg/h may be the correct amount to induce alkaline diuresis within the first 12 h after crush injuries. The use of OAS for this purpose should be evaluated further.
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Affiliation(s)
- Ramin Tolouian
- Griffin Hospital, Yale University School of Medicine, Derby, CT, USA.
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Deschauer M, Wieser T, Zierz S. Muscle carnitine palmitoyltransferase II deficiency: clinical and molecular genetic features and diagnostic aspects. ACTA ACUST UNITED AC 2005; 62:37-41. [PMID: 15642848 DOI: 10.1001/archneur.62.1.37] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Muscle carnitine palmitoyltransferase (CPT) II deficiency is an autosomal recessive disorder of fatty acid oxidation characterized by attacks of myalgia and myoglobinuria. This review summarizes the clinical features of this disease, analyzing data of 28 patients with biochemically and genetically confirmed CPT II deficiency. The review shows that exercise-induced myalgia is the most frequent symptom, whereas myoglobinuria, known as the clinical hallmark, is missing in 21% of the patients. Typically, myalgia starts in childhood, whereas attacks with myoglobinuria mostly emerge in adolescence or early adulthood. However, there are also patients with only myalgia, patients with attacks triggered by factors other than exercise, and patients with late-onset disease. Molecular or biochemical analysis is necessary for diagnosis, since no myopathologic hallmark exists. For screening patients, analysis of not only the common S113L mutation but also the P50H and Q413fs-F448L mutations is recommended. The phenotype of muscle CPT II deficiency might be influenced by the underlying mutation, and patients with a truncating mutation on 1 allele might be affected more severely.
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Affiliation(s)
- Marcus Deschauer
- Department of Neurology, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097 Halle/Saale, Germany.
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Fukuda T, Sugie H, Ito M, Sugie Y, Saito K, Nishino I, Shimizu T. [Nation-wide survey on muscle glycogen storage disease (MGSDs) and comparison with our experiences in diagnosis of MGSDs]. Rinsho Shinkeigaku 2003; 43:243-8. [PMID: 12931628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
To clarify the actual frequency of each type of muscle glycogen storage diseases (MGSDs) in Japan, we performed nation-wide survey in 2001. We compared the results with our diagnostic experiences at Hamamatu City Medical Center for Developmental Medicine. The majority (approximately 80%) of the MGSDs consisted of type II, V and III in Japan. In our experiences, most of the patients were diagnosed by the assays of glycolytic enzyme activities using biopsied skeletal muscles. However, the biochemical diagnoses of MGSDs type II, III, IV, and IX can be made using blood samples. Additionally, common genetic mutation (708/709 delTTC) of myophosphorylase gene has been found approximately in 50% of the Japanese patients with MGSDs type V. Therefore, approximately 70% of the MGSDs may be diagnosed by biochemical and genetic analysis using blood samples. Additional survey on McArdle's disease showed that the onset of muscle symptoms in McArdle's disease were variable, however, fixed muscular symptoms such as muscle weakness and muscle atrophy were present in 45% of patients.
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Affiliation(s)
- Tokiko Fukuda
- Department of Pediatric Neurology, Hamamatsu City Medical Center for Developmental Medicine
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Papalia T, Bonofiglio R, De Napoli N. [Myoglobinuric acute renal failure secondary to convulsion]. G Ital Nefrol 2003; 20:306-7. [PMID: 12881855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Myoglobinuric acute renal failure secondary to convulsion.
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Affiliation(s)
- T Papalia
- U.O. Nefrologia, Dialisi e Trapianto, Azienda Ospedaliera di Cosenza, Cosenza.
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Affiliation(s)
- Gavin V McDonnell
- Department of Neurology, Ward 21, Quin House, Royal Victoria Hospital, Belfast, County Antrim, Northern Ireland BT12 6BA, UK.
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Abstract
An 8-year-old boy was referred for recent onset of easy fatigue. He showed hyperCKemia and mild scapular winging. Muscle biopsy on the quadriceps muscle demonstrated slight fibre size variability. Dystrophin was normally distributed, carnitine palmitoyl transferase and glycolytic enzymes had normal activities. In the following years the patient developed exercise intolerance and myoglobinuria. Immunohistochemistry showed marked reduction of alpha-sarcoglycan, confirmed by Western blotting. Molecular analysis revealed compound heterozygosity with Arg284Cys and Glu137Lys substitutions, corresponding to nucleotide changes C850 T and G409 A in the gene. At present the patient, 20 years old, shows mild proximal weakness with prominent involvement of the paraspinal muscles, dorsal kyphosis and lumbar hyperlordosis. Exercise intolerance and myoglobinuria, already described in Becker muscular dystrophy, should be also considered among the possible presentations of sarcoglycan deficiencies.
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Affiliation(s)
- T Mongini
- P Peirolo Centre for Neuromuscular Diseases, Department of Neurosciences, University of Turin, Italy.
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Abstract
A 15-year-old Chinese boy developed rhabdomyolysis with myoglobinuria and marked elevation of serum creatine phosphokinase following a prolonged and severe attack of asthma. He recovered after vigorous hydration and supportive treatment. Clinicians should be aware of this potentially fatal, albeit rare, complication of status asthmaticus.
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Affiliation(s)
- A M Li
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
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Ahsan SK, Washington RJ, Ahsan N. Myoglobinuria: evaluation of methods in the clinical diagnosis acute renal failure. Indian J Med Sci 2001; 55:443-52. [PMID: 12026508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Patients with red--brown urine which may be a sign of myoglobinuria, can develop acute renal failure. We assayed serum creatinine, blood urea nitrogen (BUN) and creatine kinase activity in a total of 33 patients of equal groups, A (automobile accident), B (trauma) and C (undergoing rhabdomyolysis). In addition we tested 132 urine samples for the presence of myoglobin using a dipstick assay. Only five patients in group A showed any sign of myoglobinuria with increased creatine kinase activity upto 7 times the normal value but their serum creatinine level and BUN were within the normal range. In contrast, all 22 patients in group B and C showed myoglobinuria and above normal concentrations of serum creatinine and BUN, with significantly increased (p < 0.0001) creatine kinase activity upto 150 times the normal range. Four of the most seriously ill patients in group C developed acute renal failure. Supplementation of routine determinations of serum creatinine and BUN and serum creatine kinase activity with a rapid test for myoglobinuria provides an extra indication of impending renal dysfunction. It may be beneficial in the emergency management of these patients.
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Affiliation(s)
- S K Ahsan
- Department of Pathology, College of Medicine, King Faisal University, P.O. Box 2114, Dammam 31451, Saudi Arabia.
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Hermesh H, Manor I, Shiloh R, Weizman R, Munitz H. Absence of myoglobinuria in acute psychotic patients with marked elevation in serum creatine phosphokinase level. Eur Neuropsychopharmacol 2001; 11:111-5. [PMID: 11313156 DOI: 10.1016/s0924-977x(00)00139-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Elevated levels of serum creatine phosphokinase, muscular type (CK(MM)) are caused primarily by diseased muscle fiber. Acute psychoses are often associated with a marked increase in serum CK(MM) levels, though the reason remains obscure. Since striated muscle damage is also associated with pigmenturia and myoglobinuria, we sought to determine whether the markedly high serum CK level of acute psychosis reflects skeletal muscle damage by evaluating urinary myoglobin in affected patients. Baseline serum CK was measured on admission in 713 consecutive acute psychotic inpatients (BPRS> or =40). Those showing a serum CK levels above 1000 IU/l on the first 2 days of hospitalization underwent urine collection for myoglobin testing. Patients with physical trauma or medical conditions known to cause CKemia were excluded. Twenty-five patients were eligible for the study. In no case did myoglobinuria or pigmenturia accompany the marked CKemia. There is an unexpected dissociation between the robust increase in the serum CK(MM) levels and the absence of myoglobinuria in acute psychosis. Our negative finding may indicate that the serum CK threshold for myoglobinuria is very high (above 10000 IU/l). Alternatively, psychosis-associated CKemia may be related to an unknown, nontraumatic, pathophysiological mechanism(s).
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Affiliation(s)
- H Hermesh
- Geha Psychiatric Hospital, Rabin Medical Center, Beilinson Campus, P.O. Box 102, 49100, Petach Tiqva, Israel.
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Abstract
Renal disease is a common complication in malaria infection. In acute falciparum malaria renal involvement is usually mild, but in severe disease acute renal failure is a major problem. Acute renal failure has been attributed to ischaemic tubular necrosis from hypovolaemia resulting from vasodilatation due to endothelial injury. Though myositis is recorded as a common manifestation in falciparum malaria, only 1 case with myositis and myoglobinuria with acute renal failure has been documented; but no renal biopsy was performed in the patient. In the present study we examined the case of a 17-year-old man with severe falciparum malaria with myositis and myoglobinuria who developed acute renal failure requiring dialysis. Muscle biopsy revealed severe myositis with macrophages and T lymphocytes including CD4+ cells. The kidney biopsy showed scanty T cells and macrophages in the glomeruli which were only mildly hypercellular. The renal tubules showed myoglobin casts in the lumen and foci of interstitial inflammatory cells, including macrophages and T lymphocytes but no CD4+ cells. Rhabdomyolysis induced by macrophages and T cells with myoglobinuria and acute renal failure is a problem in severe falciparum malaria infection.
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Affiliation(s)
- R Sinniah
- Department of Pathology, National University of Singapore, Singapore
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27
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Abstract
Myoglobin has a relatively high molecular weight of 17,000 Da and is poorly cleared by dialysis (diffusion). However, elimination of myoglobin might be enhanced by an epuration modality based on convection for solute clearances. We present a single case of myoglobin-induced renal failure (peak creatine kinase level: 313,500 IU/l) treated by continuous venovenous hemofiltration (CVVH). Our purpose was to evaluate the efficiency of such a modality using an ultrafiltration rate of 2 to 3 l/h for myoglobin removal and clearance. The hemofilter was a 0.9 m(2) polyacrylonitrile (AN69) membrane Multiflow-100 (Hospal-Gambro, St-Leonard, Canada) and the blood flow rate was maintained at 150 ml/min by an AK-10 pump (Hospal-Gambro, St-Leonard, Canada). The ultrafiltration bag was placed 60 cm below the hemofilter and was free of pump control or suction device. Serum myoglobin concentration was 92,000 microg/l at CVVH initiation and dropped to 28,600 microg/l after 18 h of the continuous modality. The mean sieving coefficient for myoglobin was 0.6 during the first 9 h of therapy and this decreased to 0.4 during the following 7 h. Mean clearance of myoglobin was 22 ml/min, decreasing to 14 ml/min during corresponding periods, while the mean ultrafiltration rates were relatively stable at 2,153 +/- 148 ml/h and 2,074 +/- 85 ml/h, respectively. In contrast to myoglobin, the sieving coefficeint for urea, creatinine, and phosphorus remained stable at 1.0 during the first 16 h of CVVH. More than 700 mg of myoglobin were removed by CVVH during the entire treatment. In conclusion, considerable amounts of myoglobin can be removed by an extracorporeal modality allowing important convective fluxes and middle molecule clearances, such as CVVH at a rate of 2 to 3 l/h using an AN69 hemofilter. If myoglobin clearance had been maintained at 22 ml/min, 32 l of serum would have been cleared per day. However, the sieving coefficient of myoglobin decreased over time, probably as a consequence of protein coating and/or blood clotting of the hemofilter. Whereas myoglobin can be removed by CVVH, it remains unknown at this point if such a modality, applied early, can alter or shorten the course of myoglobinuric acute renal failure.
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Affiliation(s)
- S L Amyot
- Departments of Intensive Care, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Quebec, Canada
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28
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Abstract
A variety of conditions can lead to rhabdomyolysis. Only a few cases of rhabdomyolysis resulting from near-drowning exist in the literature. We describe a victim of near-drowning who developed rhabdomyolysis and acute renal failure requiring dialysis. We review the existing literature on near-drowning-induced rhabdomyolysis and discuss the possible pathogenesis.
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Affiliation(s)
- R Bonnor
- Department of Medicine, University of Texas Medical Branch at Galveston, 77555, USA
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Elizalde-Sciavolino C, Racco A, Proscia-Lieto T, Kleiner M. Severe hyponatremia, neuroleptic malignant syndrome, rhabdomyolysis and acute renal failure: a case report. Mt Sinai J Med 1998; 65:284-8. [PMID: 9757749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Acute renal failure secondary to myoglobinuria is a rare yet possible complication of malignant neuroleptic syndrome associated with the use of dopamine antagonists. We describe the case of a 42-year-old schizophrenic man who presented with severe hyponatremia, and proceeded to acute malignant neuroleptic syndrome, rhabdomyolysis, and acute renal failure. We contend that the acute hyponatremia may have served as a precipitating factor.
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Shoji T, Nishikawa Y, Saito N, Hayashi T, Togawa M, Okada N, Tsubakihara Y. A case of Becker muscular dystrophy and massive myoglobinuria with minimal renal manifestations. Nephrol Dial Transplant 1998; 13:759-60. [PMID: 9550662 DOI: 10.1093/ndt/13.3.757] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- T Shoji
- Department of Nephrology, Osaka Prefectural General Hospital, Japan
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Chinnery PF, Johnson MA, Taylor RW, Lightowlers RN, Turnbull DM. A novel mitochondrial tRNA phenylalanine mutation presenting with acute rhabdomyolysis. Ann Neurol 1997; 41:408-10. [PMID: 9066365 DOI: 10.1002/ana.410410319] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We describe a patient who presented with acute rhabdomyolysis and had 68% cytochrome c oxidase (COX)-deficient fibers in skeletal muscle. Further investigations confirmed a respiratory chain defect that was associated with a novel heteroplasmic point mutation in the phenylalanine tRNA gene of the mitochondrial genome (mtDNA). Analysis of single muscle fibers revealed a significantly greater level of mutant mtDNA in COX-negative fibers. This is the first case of a mitochondrial tRNA gene point mutation presenting with acute rhabdomyolysis and recurrent myoglobinuria.
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Affiliation(s)
- P F Chinnery
- Department of Neurology, University of Newcastle upon Tyne, UK
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Abstract
In this article, I review various causes of exogenous myoglobinuria(MU) and its pathogenesis in 26 consecutive patients admitted to emergency room, Asan Medical Center and determine whether there is a relationship between concentration of urine myoglobin(Mb) and acute renal failure(ARF) as a complication of MU. Serum and urine Mb were measured by RIA using myoglobin kit(Daiichi, Inc., Tokyo, Japan). The most common disorder of MU was septic shock with hypotension, followed by crush syndrome, major arterial occlusion by thormbosis, alcohol intoxication with status epilepticus, intoxication of unidentified snake venom and drug ingestion. On the basis of this limited amount of data, there is a significant association between high concentration in urine Mb(> 300 ng/ml) and ARF(Fisher's exact test, p < 0.005). To minimize the chances of development of ARF, routine urine Mb levels should be checked on patients at risk, especially septic shock with hypotension.
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Affiliation(s)
- K K Kim
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea
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Abstract
Between 1990 and 1993, we studied 14 cases of acute renal failure due to prolonged muscular exercise (e.g., squat jumping, sit-ups) and blunt trauma inflicted by law enforcement personnel using sticks or leather belts. None of the patients had a prior history of myopathy, neuropathy, or renal disease. All were critically ill and required renal support in the form of dialysis. Although the morbidity was high, 13 of the patients recovered normal renal function. One patient expired due to sepsis.
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Affiliation(s)
- R Naqvi
- Sindh Institute of Urology and Transplantation Civil Hospital, Dow Medical College Karachi, Pakistan
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Abstract
A case of rhabdomyolysis following an asthmatic attack is reported. A 71-year-old man was admitted because of wheezing and hypoxemia. Brown urine was present on admission. Although these symptoms completely disappeared with the treatment with aminophylline, salbutamol and corticosteroid, transiently elevated serum creatine phosphokinase and myoglobinuria were present. Rhabdomyolysis has rarely been reported in cases of bronchial asthma. This case represents an extremely rare case of rhabdomyolysis following status asthmaticus.
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Affiliation(s)
- T Bando
- Department of Internal Medicine, Toyama Rosai Hospital, Uozu, Japan
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Abstract
Type II carnitine palmitoyltransferase deficiency is the most common cause of exercise-induced rhabdomyolysis, myoglobinuria, and proximal muscle weakness and pain in young adults. A lack of this enzyme impairs mitochondrial oxidation of long-chain fatty acids and can lead to rhabdomyolysis, myoglobinuria, and renal failure. Carnitine palmitoyltransferase deficiency, unusual but not rare, is often detected by finding elevated creatine phosphokinase level in a routine blood chemistry panel. A case of carnitine palmitoyltransferase deficiency in a college athlete is presented, and the disorder is compared with defective myophosphorylation in McArdle's disease, the next most frequent cause of similar symptoms.
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Affiliation(s)
- H C Faigel
- University Health Services, Brandeis University, USA
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Karam H, Bruneval P, Clozel JP, Löffler BM, Bariéty J, Clozel M. Role of endothelin in acute renal failure due to rhabdomyolysis in rats. J Pharmacol Exp Ther 1995; 274:481-6. [PMID: 7616435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Rhabdomyolysis and other causes of massive myoglobin release are often complicated by an acute ischemic renal failure. We tested the hypothesis that endothelin-1, the most potent renal vasoconstrictor known, plays a role in the renal toxicity of myoglobin. For this purpose, we induced rhabdomyolysis (8 ml/kg i.m. of a 50% glycerol solution) in rats pretreated or not pretreated with bosentan, a novel potent nonpeptide endothelin receptor antagonist. Glycerol decreased renal function dramatically, increased proteinuria and induced a massive tubular necrosis. This effect was associated with a 22% increase in plasma endothelin concentration. Bosentan prevented the decrease in creatinine clearance (1.12 +/- 0.07 ml/min vs. 0.83 +/- 0.05 ml/min, P < .01), the increase in proteinuria (19.9 mg/24 hr vs. 31.8 mg/24 hr, P < .001) and the tubular necrosis induced by glycerol (as assessed by histopathological evaluation), without affecting myoglobinuria. Involvement of endothelin was further suggested by the observation that myoglobin could markedly increase endothelin-1 release by rat mesangial cells in culture. We conclude that endothelin is, at least in part, responsible for the massive tubular necrosis observed in myoglobinuric nephropathy.
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Affiliation(s)
- H Karam
- Pharma Division, F. Hoffmann-La Roche Ltd., Basel, Switzerland
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Lazar AI. Myoglobinuric versus rhabdomyolytic ARF. J Assoc Physicians India 1995; 43:305-6. [PMID: 8713285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Eustace S, McEnif N, Rastegar J, Roizental M, Costello P. Acute HIV polymyositis with complicating myoglobinuric renal failure: CT appearance. J Comput Assist Tomogr 1995; 19:321-3. [PMID: 7890866 DOI: 10.1097/00004728-199503000-00031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- S Eustace
- Department of Radiology, Brigham and Womens Hospital, Boston, MA 02115
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Makino H, Nagake Y, Moriwaki K, Hirakawa S, Katayama T, Yanai H, Takahashi K, Akagi T, Ota Z. Thrombotic thrombocytopenic purpura and myoglobinuric acute renal failure following radiation therapy in a patient with polymyositis and cervical cancer. Intern Med 1995; 34:24-7. [PMID: 7718974 DOI: 10.2169/internalmedicine.34.24] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
A 73-year-old woman was admitted to receive radiation treatment for uterine cervical cancer, however a complex series of events ensued, leading to death. She developed an acute exacerbation of polymyositis complicated by thrombotic thrombocytopenic purpura, rhabdomyolysis and acute renal failure. Radiation therapy may have produced an immune disturbance leading to the acute exacerbation of polymyositis. Auto-immune-mediated endothelial damage might have triggered a series of events leading to thrombotic thrombocytopenic purpura. Rhabdomyolysis seemed to be the main cause of acute renal failure.
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Affiliation(s)
- H Makino
- Third Department of Internal Medicine, Okayama University Medical School
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41
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Abstract
Lactate dehydrogenase M-subunit deficiency was first reported 1980 as an exertional myoglobinuria. Since then, 6 Japanese and 3 Caucasian families have been reported. Also, typical skin lesions were observed in 1 Japanese patient. Since then, 2 families, one Japanese and one Caucasian, have been found with this typical skin eruption. The metabolic background of exertional myoglobinuria was demonstrated as a result of the impaired reoxidation of NADH produced by glyceraldehyde-3-phosphate-dehydrogenase (G3PD) action. The excess NADH was partly reoxidized by the action of alpha-glycerophosphate dehydrogenase abundant in cytosolic fraction of skeletal muscle. This enzyme reoxidizes excess NADH simultaneously draining out triose phosphate from the glycolytic pathway. Abortive glycolysis results in impaired ATP production followed by rhabdomyolysis. Genomic analysis revealed the heterogeneities of the mutations of this disease.
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Affiliation(s)
- T Kanno
- Department of Laboratory Medicine, Hamamatsu University School of Medicine, Japan
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Mishra SK, Satpathy SK, Satpathy R, Nanda NC. Myoglobinuric renal failure following rhabdomyolysis. J Assoc Physicians India 1994; 42:911-2. [PMID: 7868499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- S K Mishra
- Department of Internal Medicine, Ispat General Hospital, Rourkela, Orissa
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Lazar AI. Acute myositis complicated by myoglobinuric acute renal failure. J Assoc Physicians India 1994; 42:507-8. [PMID: 7852246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Gollub MJ, Yee JM. Unusual pattern of reversible renal hyperechogenicity associated with acute myoglobinuric renal failure. J Clin Ultrasound 1994; 22:279-281. [PMID: 8006190 DOI: 10.1002/jcu.1870220413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- M J Gollub
- Department of Radiology, New York University/Bellevue Hospital Center, New York
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Abstract
A case of a young muscular male presenting in anuric acute renal failure after cocaine use with a distal obstructive nephropathy by myoglobin casts is presented. Insights into cocaine metabolism, adverse effects, and interaction with alcohol, diagnostic considerations, and mechanisms involved in renal damage are addressed.
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Abstract
Two young boys were referred for evaluation of metabolic myopathy because of elevated serum levels of creatine kinase, cramps and pigmenturia. Immunohistochemical studies of dystrophin in muscle biopsies showed reduced intensity of the stain with a patchy and discontinuous pattern in most fibers. In both patients dystrophin was undetectable by immunoblotting. DNA analysis of the dystrophin gene was not informative in one patient; in the other it revealed an in-frame deletion comprising exons 3-6. These observations suggest that the two patients are affected with an unusual phenotype of Becker muscular dystrophy. Dystrophin analysis should be included in the evaluation of patients with childhood-onset of recurrent myoglobinuria.
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Affiliation(s)
- C Minetti
- Department of Neurology, College of Physicians and Surgeons of Columbia University, New York, NY 10032
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Mukherjee A, Muzumdar A. Acute renal failure secondary to myoglobinuria. J Assoc Physicians India 1993; 41:316. [PMID: 8300477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Muckart DJ, Moodley M, Naidu AG, Reddy AD, Meineke KR. Prediction of acute renal failure following soft-tissue injury using the venous bicarbonate concentration. J Trauma 1992; 33:813-7. [PMID: 1474620 DOI: 10.1097/00005373-199212000-00003] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Sixty-four patients with soft-tissue injuries were studied prospectively to determine whether an initial venous bicarbonate concentration (VBC) of less than 17 mmol/L would predict the development of myoglobin-induced acute renal failure. The VBC was > 17 mmol/L in 59 patients, seven of whom had myoglobinuria. All recovered without renal complications. The remaining five patients all had VBC < 17 mmol/L and four had myoglobinuria. Acute renal failure developed in four patients (p < 0.001). The VBC on hospital arrival was the most accurate predictor of these patients' risk for the development of acute renal failure following soft-tissue injury.
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Affiliation(s)
- D J Muckart
- Department of Surgery, University of Natal Medical School, Durban, South Africa
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Misawa K, Kawano A, Ito M, Koni I, Koizumi J, Takeda R, Aizawa Y. [A case of acute kidney failure following snake bite]. Nihon Naika Gakkai Zasshi 1992; 81:1719. [PMID: 1469327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Feinfeld DA, Cheng JT, Beysolow TD, Briscoe AM. A prospective study of urine and serum myoglobin levels in patients with acute rhabdomyolysis. Clin Nephrol 1992; 38:193-5. [PMID: 1424305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Serum and urine myoglobin levels, measured by radioimmunoassay, were determined prospectively in eight patients with acute rhabdomyolysis, within 24 hours of admission. Five patients had urine myoglobin concentrations greater than 1,000 ng/ml (normal < 5 ng/ml); four of these patients subsequently developed acute renal failure. In three patients whose urinary myoglobin levels ranged from 19 to 275 ng/ml, acute renal failure did not occur. This difference in the occurrence of acute renal failure between the two patient groups was statistically significant (p < 0.05). Mean peak serum creatinine was significantly higher in the patients with high urine myoglobin (6.4 +/- 1.3 mg/dl) compared to those with low urine myoglobin (2.2 +/- 0.3 mg/dl), p < 0.02. There was no statistical correlation between level of serum creatine phosphokinase and serum or urine myoglobin, although the serum and urine myoglobin levels correlated well with each other. These findings suggests that among other factors, urine myoglobin may need to reach a critical level in order for myoglobinuric renal failure to ensue.
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Affiliation(s)
- D A Feinfeld
- Department of Medicine, Harlem Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York 10037
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