Rhabdomyolysis and acute renal failure in severely burned patients

Stollwerck, Peter Leonard; Namdar, Thomas; Stang, Felix; Lange, Thomas; Mailänder, P.; Siemers, Frank

doi:10.1016/j.burns.2010.09.009

Cited by 24 publications

(18 citation statements)

References 38 publications

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“…Although mannitol and bicarbonate therapy have not shown promise in treating this disorder, 12 future randomized trials could examine the therapeutic benefits of newer therapies such as fenoldopam 26 or RRT. 27,28 …”

Section: Discussionmentioning

confidence: 98%

Association of Rhabdomyolysis With Renal Outcomes and Mortality in Burn Patients

Stewart

Cotant²,

Tilley

et al. 2013

Journal of Burn Care & Research

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The contribution of rhabdomyolysis to acute kidney injury (AKI) in the context of burn injury is poorly studied. We sought to determine the impact of rhabdomyolysis on AKI (defined by the AKI Network classification), renal replacement therapy (RRT), and death. Patients admitted to the burn unit at our institution were examined. Information on sex, age, presence of inhalation injury, electrical burn, percentage TBSA burned, percentage of full-thickness burns, Injury Severity Score, and peak creatine kinase (CK) were recorded. These variables were examined via multivariate logistic regression analysis against AKI Network stage, RRT, and death. Of 1973 consecutive admissions meeting the inclusion criteria, 525 met our eligibility criteria. Log peak CK was found to be correlated with any stage of AKI (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.36-2.16; P < .0001), moderate to severe AKI (OR, 2.09; 95% CI, 1.40-3.11; P = .0003), need for RRT (OR, 1.67; 95% CI, 1.16-2.40; P = .0057), and mortality (OR, 1.49; 95% CI, 1.01-2.20; P = .0441), after adjustment. Each 10-fold increase in peak CK was associated with a 70% increase in the odds of AKI, more than a 100% increase in the odds of moderate to severe AKI, a nearly 70% increase in the odds of RRT, and an almost 50% increase in the odds of mortality in patients with burn injury.

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Section: Discussionmentioning

confidence: 98%

Association of Rhabdomyolysis With Renal Outcomes and Mortality in Burn Patients

Stewart

Cotant²,

Tilley

et al. 2013

Journal of Burn Care & Research

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“…The incidence of all-cause AKI associated with critical burns is high at 39.1% [16]. However, a 10-year retrospective review of 714 severely burned patients revealed a 1% incidence of rhabdomyolysis [17]. A smaller retrospective study found the incidence of late-onset rhabdomyolysis to be as high as 9% in severely burned patients [18].…”

Section: Discussionmentioning

confidence: 99%

Autologous Creatinine Clearance in a Case of Necrotizing Fasciitis and Anuria

Eadon

Koyner

2012

Am J Nephrol

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Necrotizing fasciitis can present with concomitant acute kidney injury. The etiology of acute kidney injury is often multifactorial; potential sources include volume depletion, abdominal compartment syndrome, rhabdomyolysis, and acute tubular necrosis (which may be related to hemodynamic instability, medications, or sepsis/infection). Kidney injury, defined via changes in serum creatinine, portends increased morbidity and mortality. Thus, it is crucial to accurately diagnose and assess the severity of kidney injury. We present the case of a patient with necrotizing fasciitis who endured 31 consecutive days of complete anuria. His serum creatinine decreased over this interval without the use of extracorporeal hemofiltration or dialysis. The explanation for this novel phenomenon lies in massive daily sero-sanguineous discharge and insensible losses with subsequent volume resuscitation. The patient's own convective clearance was substantial enough to maintain a modest creatinine clearance of 15 ml/min during sustained anuria. Our case emphasizes the importance of employing the creatinine, estimated glomerular filtration rate, and urine output portions of the Acute Kidney Injury Network (AKIN) or Risk Injury Failure Loss End stage (RIFLE) criteria in assessing the severity of kidney injury. It further reinforces the imperfection in using serum creatinine as a primary measure of glomerular filtration rate.

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“…Sin embargo, también debe sospecharse rabdomiolisis en los pacientes con quemaduras eléctricas y con picaduras extensas. Durante todos los procesos hay una ruptura mecánica del sarcolema con liberación subsecuente de sustancias al torrente sanguíneo (15,16).…”

Section: Traumaunclassified

“…En los estadios iniciales la relación BUN/creatinina se encuentra baja por aumento de la creatinina en sangre secundaria al catabolismo muscular; en los estadios tardíos la mioglobina se metaboliza a urea por lo cual la relación BUN/creatinina aumenta en forma desproporcionada con respecto a las lesiones renales por otras causas (15,16,18,23,25,(30)(31)(32)(33)42,43,45,(47)(48)(49).…”

Section: Productos Nitrogenadosunclassified

Insuficiencia renal aguda inducida por rabdomiolisis

Nieto-Ríos

Vega-Miranda

Higuita

2016

iatreia

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RESUMENLa insuficiencia renal aguda (IRA) es una causa frecuente de morbilidad y mortalidad en los servicios de urgencias, hospitalización y cuidado crítico, siendo la rabdomiolisis responsable del 15 % de los casos en los centros hospitalarios de alta complejidad. La rabdomiolisis consiste en daño muscular con necrosis y liberación a la circulación de componentes intracelulares, y puede tener múltiples causas. El daño renal por rabdomiolisis es multifactorial e incluye obstrucción tubular, vasoconstricción y daño oxidativo. El tratamiento principal de la IRA por rabdomiolisis es la hidratación, forzar la diuresis y evitar los fármacos nefrotóxicos. Cuando el daño es lo suficientemente grave para causar uremia, acidosis metabólica, hiperpotasemia y sobrecarga de volumen se debe recurrir a la terapia de reemplazo renal. Aunque la regla es que se recupere la función renal, estos pacientes tienen mayor riesgo futuro de desarrollar enfermedad renal crónica. PALABRAS CLAVEInsuficiencia Renal Aguda; Mioglobina; Músculo Esquelético; Necrosis; Rabdomiolisis SUMMARY Acute renal failure due to rhabdomyolyisisAcute renal failure is a frequent cause of morbidity and mortality in emergency, hospitalization and critical care services. In 15 % of cases it is due to rhabdomyolysis, in which there is breakdown of skeletal muscle with massive necrosis and leakage of muscle cell contents into the circulation. It has many different etiologies. The rhabdomyolysis-induced acute kidney injury results from the combination of several mechanisms, including tubular obstruction, vasoconstriction and oxidative stress. The most important therapeutic measures are: Aggressive repletion of fluids, forced diuresis and avoidance of exposure to nephrotoxic substances. In cases of

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Rhabdomyolysis and acute renal failure in severely burned patients

Cited by 24 publications

References 38 publications

Association of Rhabdomyolysis With Renal Outcomes and Mortality in Burn Patients

Association of Rhabdomyolysis With Renal Outcomes and Mortality in Burn Patients

Autologous Creatinine Clearance in a Case of Necrotizing Fasciitis and Anuria

Insuficiencia renal aguda inducida por rabdomiolisis

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