A “crush” course on rhabdomyolysis: risk stratification and clinical management update for the perioperative clinician

Cote, Devan R; Fuentes, Eva; Elsayes, Ali; Ross, Jonathan J.; Quraishi, Sadeq A.

doi:10.1007/s00540-020-02792-w

Cited by 11 publications

(16 citation statements)

References 129 publications

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“…A median myoglobin level of > 25,000 ng/ml before the start of CS therapy underlines the massive rhabdomyolysis. Although all conservative therapeutic options should be exhausted to avoid a crush kidney [9,19], acute renal failure can usually not be avoided, especially at such high myoglobin concentrations.…”

Section: Discussionmentioning

confidence: 99%

Blood purification with a cytokine adsorber for the elimination of myoglobin in critically ill patients with severe rhabdomyolysis

et al. 2021

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Background Rhabdomyolysis is frequently occurring in critically ill patients, resulting in a high risk of acute kidney injury (AKI) and potentially permanent kidney damage due to increased myoglobin levels. The extracorporeal elimination of myoglobin might be an approach to prevent AKI, but its molecular weight of 17 kDa complicates an elimination with conventional dialysis membranes. Question of interest is, if myoglobin can be successfully eliminated with the cytokine adsorber Cytosorb® (CS) integrated in a high-flux dialysis system. Methods Patients were included between 10/2014 and 05/2020 in the study population if they had an anuric renal failure with the need of renal replacement therapy, if CS therapy was longer than 90 min and if myoglobin level was > 5.000 ng/ml before treatment. The measurement times of the laboratory values were: d-1 = 24–36 h before CS, d0 = shortly before starting CS and d1 = 12–24 h after starting CS treatment. Statistical analysis were performed with Spearman’s correlation coefficient, Wilcoxon test with associated samples and linear regression analysis. Results Forty-three patients were included in the evaluation (median age: 56 years, 77% male patients, 32.6% ECMO therapy, median SAPS II: 80 points and in-hospital mortality: 67%). There was a significant equilateral correlation between creatine kinase (CK) and myoglobin at all measurement points. Furthermore, there was a significant reduction of myoglobin (p = 0.03, 95% confidence interval (CI): − 9030, − 908 ng/ml) during CS treatment, with a median relative reduction of 29%. A higher median reduction of 38% was seen in patients without ongoing rhabdomyolysis (CK decreased during CS treatment, n = 21). In contrast, myoglobin levels did not relevantly change in patients with increasing CK and therefore ongoing rhabdomyolysis (n = 22, median relative reduction 4%). Moreover, there was no significant difference in myoglobin elimination in patients with and without ECMO therapy. Conclusion Blood purification with Cytosorb® during high-flux dialysis led to a significant reduction of myoglobin in patients with severe rhabdomyolysis. The effect might be obscured by sustained rhabdomyolysis, which was seen in patients with rising CK during treatment. Prospective clinical trials would be useful in investigating its benefits in avoiding permanent kidney damage.

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Section: Discussionmentioning

confidence: 99%

Blood purification with a cytokine adsorber for the elimination of myoglobin in critically ill patients with severe rhabdomyolysis

et al. 2021

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“…In rhabdomyolysis, hyperkalemia is the most significant electrolyte abnormality. 54 Hepatic dysfunction occurs in approximately 25% of patients with rhabdomyolysis. Proteases released from injured muscle may be implicated in hepatic inflammation.…”

Section: Discussionmentioning

confidence: 99%

Rhabdomyolysis: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document

Kodadek

Carmichael

Seshadri

et al. 2022

Trauma Surg Acute Care Open

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Rhabdomyolysis is a clinical condition characterized by destruction of skeletal muscle with release of intracellular contents into the bloodstream. Intracellular contents released include electrolytes, enzymes, and myoglobin, resulting in systemic complications. Muscle necrosis is the common factor for traumatic and non-traumatic rhabdomyolysis. The systemic impact of rhabdomyolysis ranges from asymptomatic elevations in bloodstream muscle enzymes to life-threatening acute kidney injury and electrolyte abnormalities. The purpose of this clinical consensus statement is to review the present-day diagnosis, management, and prognosis of patients who develop rhabdomyolysis.

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“…In simple terms, rhabdomyolysis is the necrosis of muscle and subsequent release of intracellular components into circulation. It is now evident that rhabdomyolysis and resultant myoglobinuric AKI is a common and potentially life-threatening syndrome characterized by release of toxic muscle cell contents into the circulation [ 15 , 16 , 17 , 18 ]. On the whole, the degree of muscle damage rather than initiating factor may determine the clinical course of rhabdomyolysis ranging from asymptomatic illness to a life-threatening condition.…”

Section: Clinical Significancementioning

confidence: 99%

Heme Burden and Ensuing Mechanisms That Protect the Kidney: Insights from Bench and Bedside

Balla

Zarjou

2021

IJMS

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With iron at its core, the tetrapyrrole heme ring is a cardinal prosthetic group made up of many proteins that participate in a wide array of cellular functions and metabolism. Once released, due to its pro-oxidant properties, free heme in sufficient amounts can result in injurious effects to the kidney and other organs. Heme oxygenase-1 (HO-1) has evolved to promptly attend to such injurious potential by facilitating degradation of heme into equimolar amounts of carbon monoxide, iron, and biliverdin. HO-1 induction is a beneficial response to tissue injury in diverse animal models of diseases, including those that affect the kidney. These protective attributes are mainly due to: (i) prompt degradation of heme leading to restraining potential hazardous effects of free heme, and (ii) generation of byproducts that along with induction of ferritin have proven beneficial in a number of pathological conditions. This review will focus on describing clinical aspects of some of the conditions with the unifying end-result of increased heme burden and will discuss the molecular mechanisms that ensue to protect the kidneys.

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A “crush” course on rhabdomyolysis: risk stratification and clinical management update for the perioperative clinician

Cited by 11 publications

References 129 publications

Blood purification with a cytokine adsorber for the elimination of myoglobin in critically ill patients with severe rhabdomyolysis

Blood purification with a cytokine adsorber for the elimination of myoglobin in critically ill patients with severe rhabdomyolysis

Rhabdomyolysis: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document

Heme Burden and Ensuing Mechanisms That Protect the Kidney: Insights from Bench and Bedside

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