Rhabdomyolysis-induced acute kidney injury in a patient with undifferentiated connective tissue disease

Abstract

Rationale: Acute kidney injury (AKI) accounts for 8% to 16% of hospital admissions and can quadruple hospital mortality, placing a serious burden on the health economy. Acute kidney injury (AKI) is mainly caused by dehydration, shock, infection, sepsis, heart disease, or as a side-effect of nephrotoxic drugs. About 10% to 60% of patients with rhabdomyolysis develop AKI, and 10% of AKI is attributable to rhabdomyolysis. However, rhabdomyolysis-induced AKI secondary to undifferentiated connective tissue disease (UCTD) has rarely been reported before. Patient concerns: We report the case of a 50-year-old male of UCTD presented with dark brown urine, swelling and edema of the upper limbs, and decreased urine output. Diagnosis: The patient was diagnosed with rhabdomyolysis-induced AKI secondary to UCTD. Interventions: The patient was successfully treated with intravenous methylprednisolone with other supportive treatment. Outcomes: A fter 3 days of initiating treatment of medicinal charcoal tablets, sodium bicarbonate and intravenous fluids upon admission, the patient's serum creatinine changed mildly from 145.0 μmol/L to 156.0 μmol/L, but the urinary output increased from 1000 mL/24 h to 2400 mL/24 h, with his creatine kinase (CK) and myoglobin rose from 474 IU/L to 962 IU/L and from 641.5ng/mL to 1599 ng/mL, respectively. We then tried to empirically initiate UCTD therapy by giving corticosteroids. After the administration of the 40 mg of methylprednisolone daily, the serum creatinine level dropped to 97 μmol/L the second day, CK decreased to 85 IU/L within 1 week and myoglobin decreased to 65.05 ng/mL within 10 days. When maintenance dose of 4 mg daily was given, the patient showed no abnormalities in creatinine or CK levels. Lessons: There have been few reports on the association between rhabdomyolysis-induced AKI and UCTD and its mechanism remains unclear. Clinicians should be aware of UCTD as a possible cause to rhabdomyolysis-induced AKI.

Systemic lupus erythematosus presenting as hyponatremia-associated rhabdomyolysis

“…Therefore, when the cause of rhabdomyolysis is not clear, autoimmune diseases should be excluded via autoantibody screening tests. [ 17 , 28 ]…”

“…Myalgia, muscle swelling, and increased muscle enzyme levels that occur after rhabdomyolysis development are similar in inflammatory myopathy associated with immune disorders. Therefore, when the cause of rhabdomyolysis is not clear, autoimmune diseases should be excluded via autoantibody screening tests [17,28] …”

“…Therefore, when the cause of rhabdomyolysis is not clear, autoimmune diseases should be excluded via autoantibody screening tests. [17,28] To date, there are only nine English-written articles reporting on SLE patients with rhabdomyolysis since the first reported case in 1994 (Table 4). The mean age at the time of diagnosis was 35 (range: 25-45) years, and all patients were women.…”

<p>Safety of a Combined WB-EMS and High-Protein Diet Intervention in Sarcopenic Obese Elderly Men</p>

“…Rhabdomyolysis has been linked to acute kidney damage. 21 This could be further reinforced by the consumption of a high-protein diet. 36 In this study, the participant of the protein as well as the WB-EMS&P group increased their protein intake to approximately 1.7 g protein/kg body weight/day highly significant compared to the control group.…”

“…19,20 A 10-60% of pronounced events of rhabdomyolysis of any cause evoke acute kidney damage (AKI) which accounts for approximately 10% of all AKI. 21 For WB-EMS there are several investigations on acute WB-EMS effect mainly based on case reports. [22][23][24][25][26][27] Indeed, due to its ability to stimulate large muscle areas simultaneously and with regionally dedicated, in excess, supramaximal stimuli, WB-EMS might be the perfect candidate to trigger rhabdomyolysis.…”