Rhabdomyolysis and acute renal failure in children

Abstract

Acute renal failure (ARF) is an important complication of rhabdomyolysis. However, the contributing factors to the development of ARF in children with rhabdomyolysis remain obscure. The aim of this study was to clarify the factors contributing to the development of ARF in children with rhabdomyolysis. This is a retrospective review of the clinical characteristics, laboratory data, pediatric risk of mortality (PRISM) scores, the occurrence of systemic inflammatory response syndrome (SIRS) criteria, and the number of dysfunctional organs in 18 children with rhabdomyolysis seen in our hospital between 1991 and 2000. The patients were divided into an ARF group (n=9) and a non-ARF group (n=9). All patients with ARF had more than two dysfunctional organs. The incidence of dehydration, serum concentrations of myoglobin, creatinine kinase, aspartate aminotransferase, and lactate dehydrogenase, PRISM scores, and the numbers of SIRS criteria and dysfunctional organs were higher in the ARF group than the non-ARF group. The blood pH and base excess, and urinary pH were lower in the ARF group than in the non-ARF group. These results suggest that ARF is more likely to develop in the presence of dehydration, metabolic acidosis, or severe muscle damage, or with multiple organ failure in children with acute rhabdomyolysis.

Utility of Urine Myoglobin for the Prediction of Acute Renal Failure in Patients with Suspected Rhabdomyolysis: A Systematic Review

“…In 42 of the 52 studies that reported sex, there were more male (71%) than female patients. Most of the studies (n ϭ 46) were in the adult population; 6 studies focused on the pediatric population (13,15,34,41,51,61 ). ARF attributed to rhabdomyolysis presented in 35% of the adults and 20% of the children.…”

“…Serum creatine kinase (CK), also increased in rhabdomyolysis, was measured in 38 studies (11, 13-28, 30 -34, 36 -38, 40 -45, 47, 52, 56, 57, 61-63 ), and of these, only 4 had extractable data comparing uMb with CK (45,47,51,59 ). Serum myoglobin was also measured in addition to urine myoglobin in 11 studies (19,20,23,31,40,41,43,44,46,59,61 ), but only 1 study had extractable data for a contingency table (59 ).…”

“…Twenty studies looked at drugs or toxins (therapeutic/drugs of abuse, alcohol, insect venoms, snake venoms, heavy metals) (13, 14, 16, 18, 20 -23, 27, 28, 32, 33, 38, 43, 44, 52, 55, 56, 59, 63 ), 20 referred to trauma (crush injuries, motor vehicle accidents, surgery, physical torture and abuse, long-term confinement without changing position) (11, 21, 24 -26, 27, 29, 30, 34 -36, 38, 42, 44, 45, 48, 53, 54, 56, 59 ), 17 to infection (11,15,17,23,26,27,29,35,38,40,41,43,44,47,55,56,62 ), 12 to physical exertion (strainful muscle exercise, excessive muscle activity, seizures, longdistance running) (11, 23, 25-27, 30, 31, 38, 39, 43, 44, 49 ), 11 to metabolic disturbance (metabolic syndromes, endocrine disorders, electrolytes imbalances) (11,15,19,23,27,35,41,43,44,55,56 ), 9 to burns (thermal injury, high-voltage electrical injury, lightning) (19,26,35,38,46,48,50,57,58 ), 7 to asphyxiation (19,21,35,…”

Clinical Evaluation of Acute Kidney Injury in Children

“…Risk factors for acute kidney injury during an episode of rhabdomyolysis n children include dehydration, the serum concentration of myoglobin, the presence of other organ failure, and the presence of the systemic Clinical Evaluation of Acute Kidney Injury in Children inflammatory response syndrome (61). The mechanisms of injury is complex but may be related to vasoconstriction, precipitation of the pigments in the tubular lumen and/or heme-protein induced oxidant stress (62,63). If the rhabdomyolysis is a result of tissue injury with substantial third space fluid losses as occurs in a crush injury, rapid fluid resuscitation can prevent or limit the renal injury.…”

“…Hemolysis and rhabdomyolysis from any cause can result in sufficient hemoglobinuria or myoglobinuria to induce tubular injury and precipitate acute kidney injury (62,63). Risk factors for acute kidney injury during an episode of rhabdomyolysis n children include dehydration, the serum concentration of myoglobin, the presence of other organ failure, and the presence of the systemic Clinical Evaluation of Acute Kidney Injury in Children inflammatory response syndrome (61).…”