The Absence of Rhabdomyolysis-induced Renal Failure Following the World Trade Center Collapse

Goldfarb, David S.; Chung, Susie

doi:10.1016/s0002-9343(02)01188-9

Cited by 18 publications

(13 citation statements)

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“…During the collapse of the World Trade Center on 11 September 2001, nephrologists in New York City were prepared to dialyze large numbers of people with ARF in the days following the terrorist attack. Few patients were hospitalized with crush injuries, however, with only one reported case of rhabdomyolysis [20,21]. This case occurred in a 38-year-old policeman who was trapped under debris for 24 hours, who required hemodialysis for 1 month before fully recovering.…”

Section: Causes and Pathophysiologymentioning

confidence: 99%

Untitled

2004

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Rhabdomyolysis ranges from an asymptomatic illness with elevation in the creatine kinase level to a life-threatening condition associated with extreme elevations in creatine kinase, electrolyte imbalances, acute renal failure and disseminated intravascular coagulation. Muscular trauma is the most common cause of rhabdomyolysis. Less common causes include muscle enzyme deficiencies, electrolyte abnormalities, infectious causes, drugs, toxins and endocrinopathies. Weakness, myalgia and tea-colored urine are the main clinical manifestations. The most sensitive laboratory finding of muscle injury is an elevated plasma creatine kinase level. The management of patients with rhabdomyolysis includes early vigorous hydration.

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Section: Causes and Pathophysiologymentioning

confidence: 99%

Untitled

2004

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“…If this muscle injury is severe enough, cellular proteins such as creatinine phosphokinase (CPK) accumulate in the circulation and eventually are deposited in renal tubules and other organs. A minority of patients with rhabdomyolysis develop acute renal failure (due to acute tubular necrosis) and multiorgan failure [3,4].…”

Section: Introductionmentioning

confidence: 99%

Liver Aminotransferases Are Elevated with Rhabdomyolysis in the Absence of Significant Liver Injury

et al. 2010

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Rhabdomyolysis is an uncommon finding in the emergency department. However, the clinical implications of rhabdomyolysis are important, with a significant minority of patients developing acute renal failure and multiorgan failure. When present, the cause of elevated aminotransferases in the setting of rhabdomyolysis is often unclear. We sought to determine the incidence of abnormal aminotransferases (defined as aspartate aminotransferase (AST) or alanine aminotransferase (ALT)>40 U/L) in the setting of rhabdomyolysis and how the aminotransferases decrease relative to the creatine phosphokinase (CPK) concentration as rhabdomyolysis resolves. A retrospective chart review of 215 cases of rhabdomyolysis with CPK of >or=1,000 U/L was performed. The incidence of an abnormal AST in the setting of rhabdomyolysis was 93.1% (95% confidence interval, 88.7% to 95.8%). An abnormal ALT was much less common and found in 75.0% (95% confidence interval, 68.7% to 80.2%) of patients with a CPK of >or=1,000 U/L (p<0.0001). In only one instance was the ALT>40 U/L while the AST was <40 U/L. Furthermore, AST concentrations (and not ALT) fall in parallel with CPK during the first 6 days of hospitalization for patients with rhabdomyolysis. Aminotransferase abnormalities, particularly AST, are common in the setting of rhabdomyolysis. AST concentrations decrease in parallel to CPK, suggesting skeletal muscle may be a significant source of AST elevation in these patients.

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“…Since then, rhabdomyolysis has been reported to cause up to 7% of all cases of ARF [3]. The incidence of ARF as a result of rhabdomyolysis has been reported to range from 0% to 67% in various clinical settings [25][26][27][28][29][30], depending on the inciting cause. Furthermore, another study reported that in patients treated for ARF resulting from rhabdomyolysis, nearly 4% ultimately required hemodialysis (HD) [6].…”

Section: Introductionmentioning

confidence: 99%