Diagnostic evaluation of rhabdomyolysis

Nance, Jessica; Mammen, Andrew L.

doi:10.1002/mus.24606

Cited by 181 publications

(185 citation statements)

References 215 publications

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“…By contrast, their causing of rhabdomyolysis is extremely rare, probably only at a rate of 0.4 per 10,000 person per year [16]. Despite such a low incidence rate, certain drugs such as amiodarone that this patient has been taking to control ventricular rate could increase the risk of rhabdomyolysis when combined with statins [16]. In fact, a review of the United States Food and Drug Administration post-marketing database of rhabdomyolysis (CK 10,000) showed that, of 866 cases reported between 1987 and 2001, 44% were related to combination therapy, as compared with statins alone [22].…”

Section: Discussionmentioning

confidence: 98%

“…Mild and subclinical cases of rhabdomyolysis, called in clinical practice myopathies, are typically characterized by elevated serum CK and myalgias [15]. The diagnosis of rhabdomyolysis is primarily based on myoglobinuria or a marked elevation in serum CK [16,17]. Rhabdomyolysis accounts for 13%-50% of AKI cases [18].…”

Section: Discussionmentioning

confidence: 99%

“…Its acquired causes include substance abuse, medication or toxic exposures, electrolyte abnormalities, endocrine disturbances, and autoimmune myopathies. Inherited predisposition to rhabdomyolysis can occur with disorders of glycogen metabolism, fatty acid β-oxidation, and mitochondrial oxidative phosphorylation [16]. The main driver of rhabdomyolysis induced kidney injury is myoglobin, which causes direct damage to renal proximal tubular cells, the formation of casts in distal tubules, renal vasoconstriction, and ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…Statins, also known as HMG-CoA reductase inhibitors, are frequently associated with mild muscle complaints. By contrast, their causing of rhabdomyolysis is extremely rare, probably only at a rate of 0.4 per 10,000 person per year [16]. Despite such a low incidence rate, certain drugs such as amiodarone that this patient has been taking to control ventricular rate could increase the risk of rhabdomyolysis when combined with statins [16].…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Iatrogenic AKI and Agranulocytosis: a Cautious Tale of Medication Use in Elderly Patients

Qin¹,

Cang²,

Liu³

et al. 2017

J Clin Exp Nephrol

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A 83-year-old female patient suffered from acute kidney injury a month after percutaneous coronary intervention. Two weeks before hospitalization, she experienced nausea and intermittent watery diarrhea. Laboratory test showed high levels of serum creatine kinase and lactate dehydrogenase, which were remarkably decreased after ceasing rosuvastatin and valsartan treatment. Despite the recovery of renal function, unfortunately one week later, she was diagnosed with agranulocytosis because of antibiotic therapy. When we stopped meropenem and switched to granulocyto-colony stimulating factor treatment, her white blood cell count returned to a normal range. In our case, both rhabdomyolysis and agranulocytosis were induced by drugs. We provided a literature review of the causes of acute kidney injury and the pathogenesis of rhabdomyolysis and agranulocytosis. We discussed how drugs might lead to these complications. This case highlights the need to be aware of the potential side effects of drugs, especially those given to elderly patients who are likely to be receiving several medications concurrently for managing chronic diseases.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Iatrogenic AKI and Agranulocytosis: a Cautious Tale of Medication Use in Elderly Patients

Qin¹,

Cang²,

Liu³

et al. 2017

J Clin Exp Nephrol

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“…Ez klasszikus formájában csak a betegek mintegy 10%-ánál jelentkezik, és a felnőtt betegek fele nem említ izomfájdalmat. A fenti izompanaszokat olykor (8-15%) még az izmok megduzzadása is kíséri [5,6].…”

Section: Rhabdomyolysisunclassified

Rhabdomyolysis – Mikor vessük fel metabolikus myopathia lehetőségét? Esetismertetés és diagnosztikus algoritmus

et al. 2017

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Rekurráló rhabdomyolysis miatt kezelt 46 éves nő esetét ismertetjük. Betegünknél a metabolikus myopathia hátteré-ben a zsírsav-oxidáció veleszületett zavarát, hosszú szénláncú acil-koenzim A-dehidrogenáz-hiányt diagnosztizáltunk, miután kóros acil-karnitin-és vizeletszervessav-profilt, valamint alacsony residualis enzimaktivitást detektáltunk, vé-gül genetikai vizsgálattal patogén eltérést igazoltunk. A dietoterápia bevezetése után sem kórházi kezelést igénylő metabolikus krízis nem fordult elő, sem myopathia nem alakult ki. Az eset kapcsán áttekintjük a rhabdomyolysis és a terhelés utáni izompanaszok differenciáldiagnosztikáját, különös tekintettel a metabolikus myopathiákra. Kiemeljük a zsírsav-oxidációs zavarok jellegzetességeit, illetve a hosszú szénláncú zsírsav-oxidációs zavarok akut ellátásának és gondozásának alapelveit. A metabolikus myopathiák csoportjába tartozó betegségek jól kezelhetőek, és a betegek számára megfelelő életminőséget biztosíthatunk, azonban az elsősorban zsírsav-oxidációs zavarokra jellemző, gyorsan kialakuló metabolikus krízis súlyos, akár halálos kimenetelű is lehet. Több, ebbe a csoportba tartozó betegség szerepel az újszülöttkorban szűrt anyagcsere-betegségek között, azonban esetünk ismertetésével is szeretnénk felhív-ni a figyelmet arra, hogy egyes esetekben az első tünetek csak felnőttkorban jelentkeznek. Ismétlődő rhabdomyolysis esetén bármely korú betegnél fel kell vetni az öröklődő anyagcserezavar lehetőségét. Orv Hetil. 2017; 158(47): 1873-1882. Kulcsszavak: rhabdomyolysis, zsírsav-oxidációs zavar, VLCAD-deficientia, izomanyagcsere Rhabdomyolysis -may it be a metabolic myopathy? Case report and diagnostic algorithmWe report the case of a 46-year-old female patient with recurrent rhabdomyolysis. In the background of her metabolic myopathy an inherited metabolic disorder of the fatty acid oxidation, very long-chain acyl-coenzyme A-dehydrogenase deficiency was diagnosed. The diagnosis was based on abnormal acyl-carnitine-and urine organic-acid profile in addition to low residual enzyme activity, and was confirmed by genetic testing. After introduction of dietotherapy metabolic crisis necessitating hospital admission has not occurred neither have fixed myopathic changes developed. We present here the differential diagnosis of rhabdomyolysis and exertional muscle complaints, with the metabolic myopathies in focus. The main features of fatty acid oxidation disorders are highlighted, acute and chronic managements of very long-chain acyl-coenzyme A-dehydrogenase deficiency are discussed. Metabolic myopathies respond well to treatment, so good quality of life can be achieved. However, especially in fatty acid oxidation disorders, a metabolic crisis may develop quickly and can be fatal, albeit rarely. Some of these disorders can be identified by newborn screening, but occasionally the symptoms may manifest only in adulthood.

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Association of Statin Exposure With Histologically Confirmed Idiopathic Inflammatory Myositis in an Australian Population

et al. 2018

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IMPORTANCE Statin medications are widely prescribed for cardiovascular risk reduction. Myalgia and rhabdomyolysis are well-recognized adverse effects of statins, and they resolve with the cessation of statin therapy. Idiopathic inflammatory myositis (IIM) is a heterogeneous group of autoimmune myopathies that may also be associated with statin use. Recently, statin-associated autoimmune myopathy has been recognized as a distinct entity with the presence of specific autoantibodies against hydroxymethylglutaryl-coenzyme A reductase, which results in a necrotizing myositis that does not resolve with cessation of statin therapy and requires treatment with immunosuppressive agents. OBJECTIVE To examine the association between histologically confirmed IIM and current exposure to statin medications. DESIGN, SETTING, AND PARTICIPANTS Population-based case-control study using the South Australian Myositis Database of all histologically confirmed cases of IIM diagnosed between 1990 and 2014 in patients 40 years or older (n = 221) and population-based controls from the North West Adelaide Health Study (n = 662), matched by age and sex in a 3:1 ratio of controls to cases. Data analysis using conditional logistic regression was performed from June 1, 2016, to July 14, 2017. EXPOSURES Current statin medication use. MAIN OUTCOMES AND MEASURES Unadjusted and adjusted (for diabetes and cardiovascular disease) odds ratios and 95% CIs for likelihood of inflammatory myositis. RESULTS A total of 221 IIM cases met the inclusion criteria with a mean (SD) age of 62.2 (10.8) years, and 132 (59.7%) were female. Statin exposure at the time of IIM diagnosis was 68 of 221 patients (30.8%) and 142 of 662 matched controls (21.5%) (P = .005). There was an almost 2-fold increased likelihood of statin exposure in patients with IIM compared with controls (adjusted odds ratio, 1.79; 95% CI, 1.23-2.60; P = .001). Similar results were observed when patients with necrotizing myositis were excluded from the analysis (adjusted odds ratio, 1.92; 95% CI, 1.29-2.86; P = .001). CONCLUSIONS AND RELEVANCE In this large population-based study, statin exposure was significantly associated with histologically confirmed IIM. Given the increased use of statins worldwide and the severity of IIM, increased awareness and recognition of this potentially rare adverse effect of statin exposure is needed.

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Diagnostic evaluation of rhabdomyolysis

Cited by 181 publications

References 215 publications

Iatrogenic AKI and Agranulocytosis: a Cautious Tale of Medication Use in Elderly Patients

Iatrogenic AKI and Agranulocytosis: a Cautious Tale of Medication Use in Elderly Patients

Rhabdomyolysis – Mikor vessük fel metabolikus myopathia lehetőségét? Esetismertetés és diagnosztikus algoritmus

Association of Statin Exposure With Histologically Confirmed Idiopathic Inflammatory Myositis in an Australian Population

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