Gluteal compartment syndrome after abdominal aortic aneurysm repair.

A 66-year-old man underwent emergency surgery for a ruptured abdominal aortic aneurysm associated with right common and internal iliac aneurysms. Postoperatively, his right buttock was distended and tender to compression. A CT scan revealed an extremely swollen right gluteus maximus with decreased density. Macromyoglobinuria was noted, and creatine kinase and myoglobin were elevated: 87,800 IU/l and 144,300 ng/ml, respectively. Renal function had deteriorated and he was treated with hemodialysis until the 15th postoperative day. The patient recovered without any discomfort to the buttock or intermittent claudication. To our knowledge this is the first documented case of gluteal compartment syndrome after the repair of an abdominal aortic aneurysm.

Prolonged dense nephrograms in battered children. Suspect rhabdomyolysis and myoglobinuria.

Prolonged, dense nephrograms were seen on intravenous urography in 5 cases of child abuse presenting with possible renal injury. Each child had oliguria, elevated muscle enzymes, and pigmented urine positive for blood, but without red cells on microscopic examination. These findings are suggestive of myoglobinuria. The abnormalities resolved with appropriate fluid and electrolyte management. This complication of child abuse, not previously emphasized, may be suggested by the urographic findings. Possible factors contributing to the dense nephrograms are presented.

The forearm ischaemic work test--hazardous to McArdle patients?

A 57-year-old patient suffering from late-onset McArdle's disease developed myoglobinaemia, massive myoglobinuria and marked serum creatine kinase elevation subsequent to a routinely performed forearm ischaemic work test. Twenty hours after the test, enhancement of 99mTc methylene-diphosphonate activity was demonstrated exclusively in the tested forearm. It is concluded that the forearm ischaemic work test is potentially hazardous to McArdle patients, as it might induce myoglobinuria sufficient to result in acute myoglobinuric renal failure.

Intravenous urography in experimental acute renal failure. Nephrograms and pyelograms in saline-loaded rats.

We studied renal opacification during intravenous urography in 20 rats subjected to glycerol-induced acute renal failure, with and without prior saline loading. Animals drinking saline suffered less severe renal impairment (mean plasma creatinine 175 mumol/l) than those drinking tap water (mean 341 mumol/l). Nephrograms occurred during intravenous urography in 19 rats at all levels of renal impairment, but were only followed by pyelograms in 8 with mild plasma creatinine elevation (mean 84 mumol/l). The occurrence of a pyelogram was determined not by whether an animal was drinking saline or tap water, but only by the level of renal impairment. The presence of the nephrogram throughout the range of functional impairment in acute renal failure argues against glomerular filtration as the principal route by which contrast medium reaches the nephron to produce this clinically very useful sign.

Acute renal failure in McArdle's disease and myoglobinuric states.

Reversible acute oliguric renal failure associated with skeletal muscle abnormalities due to either McArdle's disease or myoglobinuria developed in two patients. Renal angiographic and hemodynamic data revealed a preferential diffuse reduction in cortical perfusion. Arteriography showed absence of a cortical nephrogram and attenuation of the distal interlobar and arcuate arteries. Contrast medium was delayed in passage through the edematous kidney. These changes are distinct from those of chronic renal failure due to parenchymal disease. The renal arteriogram can be a useful adjunct in the differential diagnosis of acute renal failure of obscure origin.