Background: The exRML (exertional rhabdomyolysis) is a pathophysiologic condition of skeletal muscle cell damage and breakdown associated with high intensity or prolonged exercise, normal exercise under extreme circumstances, or sudden and excessive skeletal muscle contraction. It may manifest from the increase in CK (creatine kinase) or MYO (myoglobin), a protein that can cause life-threatening injury to the kidney (AKI, acute kidney injury), and may or may not be associated with myoglobinuria. Here, we presented a case of exRML with AKI, and then reviewed the related reports. Vigorous hydration, sodium bicarbonate and furosemide are key treatments. Aim: To examine an elderly patient with exRML induced AKI and the key treatment process. Case summary: A 61-year-old man left our hospital without permission after his admission and has been walking for almost 30 kms with no water and food intake, then was diagnosed exRML and exRML induced AKI with an obvious elevation of CK, MYO and decrease of eGFR (estimated glomerular filtration rate) after coming back, and was treated with vigorous hydration, loop diuresis, sodium bicarbonate, prostaglandin and Shenkang injection. After vigorous resuscitation, the patient’s renal function, CK and MYO returned normal. Conclusions: The exRML can cause serious complications such as AKI and death. Delayed diagnosis can be critical; therefore, manner of time should be taken to achieve a favorable prognosis.
References
[1]
Stanley, M., Chippa, V., Aeddula, N.R., et al. (2023) Rhabdomyolysis. StatPearls, Treasure Island.
[2]
Mohanasundaram, S., Sujit, S., Thirumalvalavan, K., et al. (2023) Rhabdomyolysis-Associated Acute Kidney Injury. Indian Journal of Nephrology, 33, 114-118. https://doi.org/10.4103/ijn.ijn_247_21
[3]
Stahl, K., Rastelli, E. and Schoser, B. (2020) A Systematic Review on the Definition of Rhabdomyolysis. Journal of Neurology, 267, 877-882. https://doi.org/10.1007/s00415-019-09185-4
[4]
Fleischer, R. (1881) Ueber Eine Neue Form Von Haemoglobinurie Bein Menschen. Berliner Klinische Wochenschrift, 18, 691.
[5]
Bywaters, E.G. and Beall, D. (1998) Crush Injuries with Impairment of Renal Function. 1941. Journal of the American Society of Nephrology, 9, 322-332. https://doi.org/10.1681/ASN.V92322
[6]
Baeza-Trinidad, R., Brea-Hernando, A., Morera-Rodriguez, S., et al. (2015) Creatinine as Predictor Value of Mortality and Acute Kidney Injury in Rhabdomyolysis. Internal Medicine Journal, 45, 1172-1178. https://doi.org/10.1111/imj.12815
[7]
Wongrakpanich, S., Kallis, C., Prasad, P., et al. (2018) The Study of Rhabdomyolysis in the Elderly: An Epidemiological Study and Single Center Experience. Aging and Disease, 9, 1-7. https://doi.org/10.14336/AD.2017.0304
[8]
Apeland, T., Danielsen, T., Staal, E.M., et al. (2017) Risk Factors for Exertional Rhabdomyolysis with Renal Stress. BMJ Open Sport & Exercise Medicine, 3, e000241. https://doi.org/10.1136/bmjsem-2017-000241
[9]
Grigorian, A., Gabriel, V., Nguyen, N.T., et al. (2020) Black Race and Body Mass Index Are Risk Factors for Rhabdomyolysis and Acute Kidney Injury in Trauma. Journal of Investigative Surgery, 33, 283-290. https://doi.org/10.1080/08941939.2018.1493162
[10]
Rojas-Valverde, D., Sánchez-Ureña, B., Crowe, J., et al. (2020) Exertional Rhabdomyolysis and Acute Kidney Injury in Endurance Sports: A Systematic Review. European Journal of Sport Science, 21, 261-274. https://doi.org/10.1080/17461391.2020.1746837
[11]
Heytens, K., De Ridder, W., De Bleecker, J., et al. (2019) Exertional Rhabdomyolysis: Relevance of Clinical and Laboratory Findings, and Clues for Investigation. Anaesthesia and Intensive Care, 47, 128-133. https://doi.org/10.1177/0310057X19835830
Harrois, A., Soyer, B., Gauss, T., et al. (2018) Prevalence and Risk Factors for Acute Kidney Injury among Trauma Patients: A Multicenter Cohort Study. Critical Care, 22, Article No. 344. https://doi.org/10.1186/s13054-018-2265-9
[14]
Freeman, M.W., Singh, A.K., Guidon, A.C., et al. (2019) Case 22-2019: A 65-Year-Old Woman with Weakness, Dark Urine, and Dysphagia. The New England Journal of Medicine, 381, 275-283. https://doi.org/10.1056/NEJMcpc1900589
[15]
Bäcker, H.C., Busko, M., Krause, F.G., et al. (2020) Exertional Rhabdomyolysis and Causes of Elevation of Creatine Kinase. The Physician and Sportsmedicine, 48, 179-185. https://doi.org/10.1080/00913847.2019.1669410
[16]
Sunder, A., Mohanty, B., Singh, A., et al. (2019) Rhabdomyolysis—Exercise Induced Nightmare. Journal of Family Medicine and Primary Care, 8, 305-307. https://doi.org/10.4103/jfmpc.jfmpc_370_18
[17]
Fathallah-Shaykh, S.A. and Cramer, M.T. (2014) Uric Acid and the Kidney. Pediatric Nephrology, 29, 999-1008. https://doi.org/10.1007/s00467-013-2549-x
[18]
Inker, L.A., Astor, B.C., Fox, C.H., et al. (2014) KDOQI US Commentary on the 2012 KDIGO Clinical Practice Guideline for the Evaluation and Management of CKD. American Journal of Kidney Diseases, 63, 713-735. https://doi.org/10.1053/j.ajkd.2014.01.416
[19]
Qi, J., Tang, Y.N., Zhang, Y.F., et al. (2015) Efficacy of Shenkang Injection Combined with Alprostadil in Treatment of Diabetic Nephropathy: A Systematic Review. Shandong Medical Journal, 55, 12-15.
[20]
Hu, S.M., Qian, Z.Y., Shi, X.S., et al, (2015) Efficacy of Shenkang Injection Combined with Alprostadil in Treatment of Diabetic Nephropathy in the Elderly. Chinese Journal of Gerontology, 35, 6533-6535.
[21]
DeWolf, M.C., Norman, M.B., Molloy, I.B., et al. (2019) Acute Tubular Necrosis from Rhabdomyolysis from Leg Compartment Syndrome: A Case Report. JBJS Case Connector, 9, e0318. https://doi.org/10.2106/JBJS.CC.18.00318
[22]
Lu, R. (2011) Effects of Low Dose Furosemide on Preventing Contrast-Induced Nephropathy at the Basic of Adequate Hydration in Patients Undergoing Coronary Angiographyl. Ph.D Thesis, Hebei Medical University, Shijiazhuang.
[23]
Chen, H. (2005) Sodium Bicarbonate fer the Prevention of Radiocontrast-Induced Nephropathy: A Prospective Randomized Controlled Trial. Ph.D Thesis, Huazhong University of Science and Technology, Wuhan.
