肾脏病学与治疗学杂志

Acute Kidney Injury and Rhabdomyolysis

Abstract

Varun Mamidi and Manikantan Shekar

Background and objectives: Rhabdomyolysis is clinical syndrome characterized by breakdown of skeletal muscle and the release of intracellular contents into the circulation. Acute kidney injury (AKI) is one of the common systemic complication of rhabdomyolysis. The aim of the study is to report the varied aetiologies of rhabdomyolysis and to study their presentation, clinical profile and outcome in patients with AKI.

Methods: Sixty-four patients are identified with rhabdomyolysis over a period of one year and out of them AKI was seen in 24 patients (37.5%%). The association of rhabdomyolysis and AKI was studied retrospectively in eight patients based on the data in our charts.

One patient from different aetiologies of rhabdomyolysis leading to AKI was taken to report the varied aetiologies and presentation of rhabdomyolysis. Hence, eight patients included in the study. Data was expressed as median.

Results: Our results show that AKI associated with rhabdomyolysis was related with comorbidity in all cases (bacterial sepsis, statin induced, chemotherapy induced, herbicide poisoning, cocaine abuse, road traffic accident, strenuous exercise, metabolic myopathy). Most common presenting symptom was myalgia followed by oliguria. Maximum median serum creatinine was 4.7 mg/dl before treatment and 1.7 mg/dl after treatment. Maximum median creatine phosphokinase levels was 2451 IU/L before treatment and 262 IU/L after treatment. Treatment given for rhabdomyolysis and acute kidney injury include either conservative treatment with adequate hydration and alkaline diuresis or invasive treatment such as renal replacement therapy or both. All the patients were treated with hydration and six patients required haemodialysis during hospital stay. Serum creatinine fell simultaneously with the decrease in creatine phosphokinase levels in all cases.

Conclusion: In conclusion, rhabdomyolysis is an uncommon and preventable cause of AKI. It is caused by varied aetiologies, hence high index of suspicion regarding rhabdomyolysis is required in patients with AKI. The presence of rhabdomyolysis associated with AKI is indicative of the presence of comorbidity, as observed in all eight patients studied here. There was an improvement of renal function in all cases as creatine phosphokinase levels decreased. Hence, timely intervention is required to prevent adverse outcomes in rhabdomyolysis.