Current View on the Use of Extracorporeal Detoxification Methods for the Treatment of Rhabdomyolysis (Review)

Abstract

Rhabdomyolysis is a syndrome caused by destruction and necrosis of muscle tissue, which is accompanied by the release of intracellular contents into the systemic circulation. The etiology of rhabdomyolysis is multifaceted, however, regardless of the etiological factor, the central element of its pathophysiology is systemic endotoxemia with multiple organ failure syndrome. Acute renal failure is one of the most common manifestations of organ dysfunction. Considering the pathogenetic model of the development of systemic endotoxemia, the timely use of extracorporeal therapy, which reduces mortality in organ failure, seems promising. All the current types of extracorporeal therapy can be divided into convection (hemofiltration), diffusion (hemodialysis), convection/diffusion (hemodiafiltration), sorption (hemoperfusion) and plasma exchange (plasmapheresis, plasma exchange, plasma sorption, etc.) methods based on physical principle.The aim of the review was to summarize the available clinical data on extracorporeal treatments for rhabdomyolysis and to assess the feasibility and best indications for these methods based on the current pathogenetic model of rhabdomyolysis.Material and methods. The search for information was carried out in the Web of Science, Scopus, Medline, PubMed, RSCI, E-library and other databases. Eighty-one sources were identified containing current therapeutic approaches and relevant data of clinical and scientific research on the subject of this review.Results. In this review, the main etiological, epidemiological and pathogenetic models of acute renal injury in rhabdomyolysis have been discussed. The main methods of extracorporeal therapy have been reviewed and evaluated based on current understanding, and latest clinical data on their effectiveness have been summarized.Conclusion. The choice of the optimal extracorporeal treatment method, the time of initiation and duration of the procedure still remain controversial. The solution to this issue can potentially help to better correct the electrolyte disturbances and could protect against organ dysfunction, which would improve the outcome in patients with rhabdomyolysis.

Rhabdomyolysis as a Consequence of Excessive Physical Activity in Children and Adolescents

“…Объем медикаментозной терапии зависит от тяжести состояния больного и направлен на профилактику развития ОПП. Экстракорпоральные методы детоксикации, элиминирущие продукты миолиза из системного кровотока, служат наиболее эффективными методами лечения осложнений рабдомиолиза [1,4,8,32].…”

“…Рабдомиолиз (код по МКБ-10: M60-M63 Болезни мышц) -клинико-лабораторный синдром повреждения и деструкции миоцитов поперечно-полосатой мускулатуры, проявляющийся миалгией, мышечной слабостью, отеком пораженных мышц, уменьшением объема и появлением мочи темнобурого цвета за счет высвобождения и попадания в системный кровоток продуктов миолиза, прежде всего миоглобина (МГ), а также креатинфосфокиназы (КФК), лизосомальных и митохондриальных ферментов, гистамина, серотонина, олиго-и полипептидов и других, с последующей манифестацией эндогенной интоксикации. Различают травматический и нетравматический рабдомиолиз [1,2]. В общеврачебной практике рабдомиолиз чаще ассоциируется с травматическим повреждением мышечной ткани [3].…”