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1.
Arch. med. deporte ; 36(192): 248-255, jul.-ago. 2019. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-185182

RESUMO

La rabdomiolisis es un síndrome clínico caracterizado por la destrucción de tejido muscular estriado y el vertido del contenido intracelular del mismo que cursa con dolor muscular por miositis, pérdida de fuerza y edema muscular. Se caracteriza pro la elevación muy importante de creatinquinasa, mioglobina, lactato deshidrogenada y puede provocar importantes complicaciones, fundamentalmente renales. En función de las cifras de CK, siempre superiores a 5000 UI/l, que se encuentran en el inicio del cuadro la rabdomiólisis se clasifica en ligera y severa. De entre las diversas causas etiológicas que la pueden provocar, desde el punto de vista del deporte, interesa la rabdomiólisis inducida por esfuerzo. Este trabajo revisa la etiología del cuadro, prestando especial atención al ejercicio como desencadenante o coadyuvante del síndrome y a las características del tipo de ejercicio (condición física y experiencia del deportista, intensidad y duración del ejercicio físico, tipo de ejercicio, condiciones ambientales, etc.) que pueden provocarla. Aunque las causas de la rabdomiolisis son muy variadas y diferentes, la vía patogénica final que conduce a la destrucción muscular es común a todas y tiene que ver con la alteración en la regulación de los electrolitos intracelulares y especialmente con los niveles de calcio citoplasmático. Además del diagnóstico analítico, actualmente, la ecografía permite un diagnóstico rápido y la observación de la evolución del cuadro. La rabdomiólisis muestra patrones de afectación muscular que se describen en el trabajo. Se describen las estrategias de prevención basadas en la realización de un ejercicio físico adecuado (tipo, intensidad y duración del ejercicio), medidas relacionadas con la nutrición y alimentación, medidas relacionadas con los factores ambientales y medidas educativas. Por último, se presenta el tratamiento inmediato del cuadro, con hospitalización necesaria en algunos casos, y las recomendaciones sobre re-incorporación al entrenamiento y a la competición deportiva


IRhabdomyolysis is a clinical syndrome characterized by the destruction of striated muscular tissue and the dumping of the intracellular content of the muscle that presents with muscle pain due to myositis, loss of strength and muscular edema. It is characterized by the high elevation of creatine kinase, myoglobin, dehydrogenated lactate and it can cause important complications, especially renal complications. According to the CK figures, always higher than 5000 IU / l, which are at the beginning of the table, rhabdomyolysis is classified as light and severe. From the point of view of sport, among the various etiological causes that can cause it, it is interesting to focus on stress-induced rhabdomyolysis. This work reviews the etiology of the clinical picture, paying special attention to exercise as a trigger of the syndrome and the characteristics of the type of exercise (physical condition and experience of the athlete, intensity and duration of physical exercise, type of exercise, environmental conditions, etc.) that can cause it. Although the causes of rhabdomyolysis are very varied and different, the final pathogenic pathway leading to muscle des-truction is common to all and has to do with the alteration in the regulation of intracellular electrolytes and especially with cytoplasmic calcium levels. Currently, in addition to the analytical diagnosis, ultrasound allows a rapid diagnosis and the observation of the evolution of the picture. Rhabdomyolysis shows muscle involvement patterns that are described in this work. Different prevention strategies are described based on the execution of an adequate physical exercise (type, intensity and duration of the exercise), measures related to nutrition and feeding, as well as measures related to environmental end educational factors. Finally, is presented the immediate treatment of the symptoms, with necessary hospitalization in some cases, and recommendations on re-incorporation to training and sports competition


Assuntos
Humanos , Rabdomiólise/complicações , Rabdomiólise/diagnóstico por imagem , Esforço Físico , Músculos/diagnóstico por imagem , Músculos/lesões , Rabdomiólise/etiologia , Rabdomiólise/genética , Transtornos Relacionados ao Uso de Substâncias/complicações , Exercício
2.
Life Sci ; 232: 116634, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31279782

RESUMO

AIM: Here, we evaluated the possible protective effects of oleuropein, the major phenolic constituent in virgin olive oil against glycerol-induced acute kidney injury (AKI) in rats. MAIN METHODS: Twenty-eight Sprague Dawley rats were allocated equally into four groups as follows: control group, oleuropein group (50 mg/kg body weight), AKI group and the oleuropein + AKI group. AKI was induced by injecting 50% glycerol (10 ml/kg body weight) intramuscularly. KEY FINDINGS: Glycerol injection increased the kidney relative weight as well as rhabdomyolysis (RM)- and AKI-related index levels, including the levels of creatine kinase, lactate dehydrogenase, creatinine, urea, and Kim-1 expression. Additionally, alteration in oxidative conditions in renal tissue was recorded, as confirmed by the elevated malondialdehyde and nitric oxide levels and the decreased glutathione content. Concomitantly, the protein and mRNA expression levels of antioxidant enzymes were suppressed. Moreover, Nfe2l2 and Hmox1 mRNA expression was also downregulated. Glycerol triggered inflammatory reactions in renal tissue, as evidenced by the increased pro-inflammatory cytokines and Ccl2 protein and mRNA expression, whereas myeloperoxidase activity was increased. Furthermore, glycerol injection enhanced apoptotic events in renal tissue by increasing the expression of the pro-apoptotic proteins and decreasing that of anti-apoptotic. However, oleuropein administration reversed the molecular, biochemical, and histological alterations resulting from glycerol injection. SIGNIFICANCE: Our data suggest that oleuropein has potential as an alternative therapy to prevent or minimize RM incidence and subsequent development of AKI, possibly due to its potent anti-stress, anti-inflammatory, and anti-apoptotic effects.


Assuntos
Lesão Renal Aguda/tratamento farmacológico , Iridoides/farmacologia , Lesão Renal Aguda/metabolismo , Animais , Antioxidantes/farmacologia , Apoptose/efeitos dos fármacos , Moléculas de Adesão Celular/metabolismo , Creatina Quinase/metabolismo , Creatinina/metabolismo , Glutationa/metabolismo , Glicerol/efeitos adversos , Glicerol/farmacologia , Inflamação/metabolismo , Iridoides/metabolismo , Rim/metabolismo , Masculino , Malondialdeído/metabolismo , Óxido Nítrico/metabolismo , Oxirredução/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Peroxidase/metabolismo , Ratos , Ratos Sprague-Dawley , Rabdomiólise/complicações
3.
Medicine (Baltimore) ; 98(30): e16492, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348259

RESUMO

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: After 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.


Assuntos
Lesão Renal Aguda/etiologia , Rabdomiólise/complicações , Doenças do Tecido Conjuntivo Indiferenciado/complicações , Humanos , Masculino , Pessoa de Meia-Idade
4.
BMJ Case Rep ; 12(5)2019 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-31126931

RESUMO

A 43-year-old man presented with acute onset rapidly progressive weakness in all four limbs (proximal greater than distal), following an episode of binge alcohol ingestion, and was admitted for evaluation and management. There was a history of decreased urine output since 2 days with dark-coloured urine. He was found to have severe hypokalemia and renal dysfunction. Serum creatine kinase was significantly high, and further investigation revealed significantly elevated serum and urine myoglobin levels suggestive of rhabdomyolysis, which was secondary to severe hypokalemia. Following supplementation with intravenous and oral potassium and supportive care, the weakness improved significantly, and he was subsequently discharged. This case describes severe hypokalemia, resulting in rhabdomyolysis and generalised lower motor neuron weakness, in a setting of binge alcohol ingestion, which is an entity rarely described in literature.


Assuntos
Bebedeira , Hipopotassemia/diagnóstico , Potássio/uso terapêutico , Rabdomiólise/diagnóstico , Administração Oral , Adulto , Diagnóstico Diferencial , Humanos , Hipopotassemia/sangue , Hipopotassemia/complicações , Hipopotassemia/tratamento farmacológico , Infusões Intravenosas , Masculino , Potássio/administração & dosagem , Rabdomiólise/complicações
5.
BMC Endocr Disord ; 19(1): 52, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31113413

RESUMO

BACKGROUND: Hypothyroidism, one of the prevalent endocrine disorders worldwide, has a broad spectrum of clinical manifestations, from an asymptomatic condition to myxedema coma. Although the majority of patients with hypothyroidism have minor clinical symptoms, which are recovered with levothyroxine treatment, some patients occasionally do experience fatal complications. Here we report, for the first time, the case of a patient who had hypothyroidism with simultaneous occurrence of rhabdomyolysis with acute kidney injury, moderate pericardial effusion, and sudden sensorineural hearing loss. CASE PRESENTATION: A 57-year-old man with a previous history of dyslipidemia and untreated hypothyroidism was admitted to the hospital due to shortness of breath, lethargy, lower extremity discomfort, and unilateral hearing loss. Laboratory results revealed rhabdomyolysis with acute kidney injury and severe hypothyroidism. We detected cardiomegaly without lung parenchymal infiltration on chest radiography and moderate pericardial effusion on transthoracic echocardiography. We performed pure tone audiometry and identified profound unilateral sensorineural hearing loss. Aggressive fluid resuscitation, levothyroxine treatment, and systemic and intratympanic steroid therapy alleviated the patient's severe hypothyroidism, rhabdomyolysis, and pericardial effusion; however, sensorineural hearing loss was not fully recovered. CONCLUSIONS: Early recognition of life-threatening complications is important in patients with severe hypothyroidism to prevent adverse outcomes. This case suggests that hypothyroidism should be considered in patients who have rhabdomyolysis with acute kidney disease and pericardial effusion. Moreover, sudden sensorineural hearing loss should be kept in mind as a rare complication of hypothyroidism.


Assuntos
Perda Auditiva Neurossensorial/patologia , Hipotireoidismo/patologia , Derrame Pericárdico/patologia , Rabdomiólise/patologia , Perda Auditiva Neurossensorial/complicações , Humanos , Hipotireoidismo/complicações , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/complicações , Prognóstico , Rabdomiólise/complicações
6.
G Ital Nefrol ; 36(2)2019 Apr.
Artigo em Italiano | MEDLINE | ID: mdl-30983179

RESUMO

Fatty acid oxidation disorders are inborn errors of metabolism. One of the possible alterations involves the failure of the carnitin-based transport of long-chain fatty acids into the mitochondria, necessary for muscle metabolism in case of prolonged physical exertion. Three kinds of Carnitin-Palmitoyl Transferase type 2 (CPT2) deficiency have been described: a myopathic form, a severe infantile form and a neonatal form. The clinical picture is characterized by recurrent attacks of rhabdomyolysis, muscular pains and fatigue, secondary to a prolonged physical exercise and sometimes aggravated by intercurrent events. Rhabdomyolysis episodes are associated with a significant increase in creatine phosphokinase and myoglobinuria and may result in acute renal failure. Patients are usually asymptomatic during intercurrent periods. When acute renal failure from rhabdomyolysis arises after intense physical activity, it is therefore necessary to also investigate the presence of metabolic myopathies due to enzymatic deficiency.


Assuntos
Lesão Renal Aguda/etiologia , Carnitina O-Palmitoiltransferase/deficiência , Esforço Físico , Rabdomiólise/complicações , Lesão Renal Aguda/terapia , Creatina Quinase/metabolismo , Fadiga/etiologia , Ácidos Graxos/metabolismo , Hidratação , Humanos , Masculino , Mitocôndrias Musculares/metabolismo , Mialgia/etiologia , Mioglobinúria/complicações , Recidiva , Adulto Jovem
8.
J Emerg Med ; 56(5): 551-553, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30898458

RESUMO

BACKGROUND: Exertional rhabdomyolysis is a common condition with potentially life-threatening consequences; early recognition can prevent severe downstream complications. Some migrants and undocumented immigrants who have travelled to the United States have encountered extreme heat or other austere conditions during their journey, many of which have involved long stretches of travel on foot. These factors can combine to put these migrants at risk for rhabdomyolysis. Hospitals near the border of Mexico and the United States commonly encounter patients with adverse medical complications related to the process of border crossing. CASE REPORT: We report a patient with exertional rhabdomyolysis complicated by acute kidney injury who presented to a hospital located thousands of miles from the United States-Mexico border. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Undocumented immigrants frequently disperse to disparate metropolitan areas after crossing the border, and therefore medical providers should remain vigilant for the medical complications of this dangerous journey.


Assuntos
Esforço Físico , Rabdomiólise/complicações , Rabdomiólise/diagnóstico , Lesão Renal Aguda/etiologia , Antibacterianos/uso terapêutico , Clindamicina/uso terapêutico , Creatina Quinase/análise , Creatina Quinase/sangue , Feminino , Fluconazol/uso terapêutico , Humanos , New York , Imigrantes Indocumentados , Adulto Jovem
9.
BMJ Case Rep ; 12(3)2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30898957

RESUMO

Rhabdomyolysis is a serious and life-threatening condition which has many established causes including endocrine disturbances. Of those, thyroid, adrenal and pituitary deficiencies are the most commonly seen. Most cases of rhabdomyolysis with adrenal insufficiency that have been reported have been primary. Here, we report an encounter with a patient who presented with her second case of severe rhabdomyolysis in the setting of secondary adrenal insufficiency. The cause for corticotropic suppression was most likely autoimmune hypophysitis given the presence of other autoimmune comorbidities including a new diagnosis of autoimmune hepatitis. In addition to her case, we present a brief review of the literature pertaining to cases of rhabdomyolysis attributed to adrenal insufficiency.


Assuntos
Insuficiência Adrenal/complicações , Hepatite Autoimune/complicações , Rabdomiólise/complicações , Creatina Quinase/sangue , Diagnóstico Diferencial , Feminino , Humanos , Hidrocortisona/sangue , Pessoa de Meia-Idade , Rabdomiólise/sangue
11.
Clin Investig Arterioscler ; 31(2): 89-92, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30738610

RESUMO

A 60-year-old male with familial combined hyperlipidemia, ischemic heart disease and type 2 diabetes. Since childhood, intolerance to intense exercise. The patient was diagnosed of McArdle's disease after an episode of rhabdomyolysis associated with statins as treatment after a myocardial infarction. Since then, he had been treated with diet, fibrates and ezetimibe with good tolerance, despite this, LDL cholesterol (cLDL) remained >180mg/dl. He started to be treated with alirocumab 150mg/sc every 14 days, with excellent clinical response and a decrease in cLDL to 15mg/dl. Our case shows that PCSK9 inhibitors are effective and safe in patients with muscle diseases who have statin contraindication, and they are a good therapeutic tool for these patients.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Doença de Depósito de Glicogênio Tipo V/etiologia , Pró-Proteína Convertase 9/antagonistas & inibidores , Rabdomiólise/induzido quimicamente , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Humanizados , Anticolesterolemiantes/efeitos adversos , Anticolesterolemiantes/farmacologia , Anticolesterolemiantes/uso terapêutico , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , LDL-Colesterol/sangue , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Hiperlipidemia Familiar Combinada/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Rabdomiólise/complicações , Fatores de Risco , Resultado do Tratamento
12.
Anesth Analg ; 128(4): 652-659, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30768455

RESUMO

At a recent consensus conference, the Malignant Hyperthermia Association of the United States addressed 6 important and unresolved clinical questions concerning the optimal management of patients with malignant hyperthermia (MH) susceptibility or acute MH. They include: (1) How much dantrolene should be available in facilities where volatile agents are not available or administered, and succinylcholine is only stocked on site for emergency purposes? (2) What defines masseter muscle rigidity? What is its relationship to MH, and how should it be managed when it occurs? (3) What is the relationship between MH susceptibility and heat- or exercise-related rhabdomyolysis? (4) What evidence-based interventions should be recommended to alleviate hyperthermia associated with MH? (5) After treatment of acute MH, how much dantrolene should be administered and for how long? What criteria should be used to determine stopping treatment with dantrolene? (6) Can patients with a suspected personal or family history of MH be safely anesthetized before diagnostic testing? This report describes the consensus process and the outcomes for each of the foregoing unanswered clinical questions.


Assuntos
Dantroleno/provisão & distribução , Hipertermia Maligna/terapia , Músculo Masseter/efeitos dos fármacos , Rabdomiólise/terapia , Succinilcolina/provisão & distribução , Consenso , Dantroleno/uso terapêutico , Esquema de Medicação , Medicina Baseada em Evidências , Exercício , Humanos , Relaxantes Musculares Centrais/provisão & distribução , Relaxantes Musculares Centrais/uso terapêutico , Fármacos Neuromusculares Despolarizantes/provisão & distribução , Fármacos Neuromusculares Despolarizantes/uso terapêutico , Rabdomiólise/complicações , Sociedades Médicas , Succinilcolina/uso terapêutico , Resultado do Tratamento , Estados Unidos
13.
Int J Neurosci ; 129(9): 930-932, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30722721

RESUMO

Rhabdomyolysis could be caused by various mechanisms including autoimmune reaction. Here, we reported a case of 76-year-old-woman diagnosed with aquaporin-4 (AQP4) IgG positive neuromyelitis optica spectrum disorder (NMOSD) following rhabdomyolysis. After a review of literature, we propose that physical injury of skeletal muscle cells may lead to the production of AQP4 IgG and this AQP4 IgG might further decrease in the stability of skeletal muscle cells creating a positive feedback loop. HyperCKemia might be an inducement of NMOSD.


Assuntos
Aquaporina 4/sangue , Autoanticorpos/sangue , Neuromielite Óptica/sangue , Neuromielite Óptica/etiologia , Rabdomiólise/sangue , Rabdomiólise/complicações , Idoso , Feminino , Humanos , Neuromielite Óptica/diagnóstico por imagem , Rabdomiólise/diagnóstico por imagem
14.
Am J Emerg Med ; 37(3): 518-523, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30630682

RESUMO

BACKGROUND: Rhabdomyolysis is a medical condition caused by muscle breakdown leading to potential renal damage. This can result in significant morbidity and mortality if not rapidly identified and treated. OBJECTIVE: This article provides an evidence-based narrative review of the diagnosis and management of rhabdomyolysis, with focused updates for the emergency clinician. DISCUSSION: Rhabdomyolysis is caused by the breakdown of muscle cells leading to the release of numerous intracellular molecules, including potassium, calcium, phosphate, uric acid, and creatinine kinase. There are a number of potential etiologies, including exertion, extreme temperature changes, ischemia, infections, immobility, drugs, toxins, endocrine causes, autoimmune reactions, trauma, or genetic conditions. Findings can include myalgias, muscle weakness, or dark-colored urine, but more often include non-specific symptoms. The diagnosis is often determined with an elevated creatinine kinase greater than five times the upper-limit of normal. Severe disease may result in renal failure, electrolyte derangements, liver disease, compartment syndrome, and disseminated intravascular coagulation. Treatment includes addressing the underlying etiology, as well as aggressive intravenous hydration with a goal urine output of 300 mL/h. Bicarbonate, mannitol, and loop diuretics do not possess strong evidence for improved outcomes. Renal replacement therapy should be determined on a case-by-case basis. Most patients are admitted, though some may be appropriate for discharge. CONCLUSION: Rhabdomyolysis is a potentially dangerous medical condition requiring rapid diagnosis and management that may result in significant complications if not appropriately identified and treated. Emergency clinician knowledge of this condition is essential for appropriate management.


Assuntos
Serviço Hospitalar de Emergência , Rabdomiólise/diagnóstico , Rabdomiólise/terapia , Biomarcadores/sangue , Creatina Quinase/sangue , Medicina Baseada em Evidências , Hidratação , Humanos , Falência Renal Crônica/terapia , Terapia de Substituição Renal , Rabdomiólise/complicações , Rabdomiólise/etiologia
16.
Paediatr Int Child Health ; 39(2): 150-153, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-29493437

RESUMO

Glucose-6-phosphate dehydrogenase (G6PD) deficiency leading to acute intravascular haemolysis and acute kidney injury (AKI) is a known clinical presentation. However, there is a paucity of information regarding the occurrence of rhabdomyolysis and myoglobinuria in G6PD-deficient individuals, especially children. An 11-year-old south Indian Tamil girl presented with severe anaemia and anuric AKI following a short febrile illness. Investigations demonstrated evidence of intravascular haemolysis and rhabdomyolysis, and on histopathology myoglobin deposits (casts) were detected in the renal tubules. She was successfully managed with repeated sessions of haemodialysis and blood transfusions. Follow-up estimation of G6PD levels after 3 months confirmed severe G6PD deficiency (0.003 nkat/g haemoglobin). Although there are anecdotal reports of myoglobinuria in G6PD-deficient individuals, the occurrence of severe anuric AKI in this clinical setting has not been reported. It can be speculated that myoglobinuria (in addition to haemoglobinuria) can contribute towards jeopardising renal function in G6PD deficiency-related acute haemolytic crisis.


Assuntos
Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/patologia , Deficiência de Glucosefosfato Desidrogenase/complicações , Hemólise , Rabdomiólise/complicações , Criança , Feminino , Histocitoquímica , Humanos , Índia , Túbulos Renais/patologia , Mioglobina/análise
17.
Crit Care ; 22(1): 344, 2018 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-30563549

RESUMO

BACKGROUND: Organ failure, including acute kidney injury (AKI), is the third leading cause of death after bleeding and brain injury in trauma patients. We sought to assess the prevalence, the risk factors and the impact of AKI on outcome after trauma. METHODS: We performed a retrospective analysis of prospectively collected data from a multicenter trauma registry. AKI was defined according to the risk, injury, failure, loss of kidney function and end-stage kidney disease (RIFLE) classification from serum creatinine only. Prehospital and early hospital risk factors for AKI were identified using logistic regression analysis. The predictive models were internally validated using bootstrapping resampling technique. RESULTS: We included 3111 patients in the analysis. The incidence of AKI was 13% including 7% stage R, 3.7% stage I and 2.3% stage F. AKI incidence rose to 42.5% in patients presenting with hemorrhagic shock; 96% of AKI occurred within the 5 first days after trauma. In multivariate analysis, prehospital variables including minimum prehospital mean arterial pressure, maximum prehospital heart rate, secondary transfer to the trauma center and data early collected after hospital admission including injury severity score, renal trauma, blood lactate and hemorrhagic shock were independent risk factors in the models predicting AKI. The model had good discrimination with area under the receiver operating characteristic curve of 0.85 (0.82-0.88) to predict AKI stage I or F and 0.80 (0.77-0.83) to predict AKI of all stages. Rhabdomyolysis severity, assessed by the creatine kinase peak, was an additional independent risk factor for AKI when it was forced into the model (OR 1.041 (1.015-1.069) per step of 1000 U/mL, p < 0.001). AKI was independently associated with a twofold increase in ICU mortality. CONCLUSIONS: AKI has an early onset and is independently associated with mortality in trauma patients. Its prevalence varies by a factor 3 according to the severity of injuries and hemorrhage. Prehospital and early hospital risk factors can provide good performance for early prediction of AKI after trauma. Hence, studies aiming to prevent AKI should target patients at high risk of AKI and investigate therapies early in the course of trauma care.


Assuntos
Lesão Renal Aguda/etiologia , Ferimentos e Lesões/complicações , Lesão Renal Aguda/epidemiologia , Adulto , Estudos de Coortes , Feminino , França/epidemiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Estudos Retrospectivos , Rabdomiólise/complicações , Rabdomiólise/etiologia , Rabdomiólise/fisiopatologia , Fatores de Risco , Ferimentos e Lesões/epidemiologia
18.
Medicine (Baltimore) ; 97(49): e13582, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30544481

RESUMO

RATIONALE: The Epstein-Barr (EB) virus has rarely been reported as a cause of fulminant myocarditis. To our knowledge, the present case is the first report on myocardial calcification in EB viral myocarditis and rhabdomyolysis. PATIENT CONCERNS: A 17-year-old man was admitted to the department with fever, chest tightness, and tachypnea that had been present for 2 days. DIAGNOSES: The initial investigation showed elevated liver enzyme levels, creatine kinase levels, creatine kinase isoenzyme levels, and elevated serum myoglobin. Echocardiography showed that left ventricular motion amplitude decreased. Test for immunoglobin M and immunoglobin G antibodies against Epstein-Barr virus were positive. These findings were consistent with fulminant myocarditis, cardiogenic shock, and rhabdomyolysis. INTERVENTIONS: The patient was intensively treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO), continuous renal replacement therapy (CRRT). OUTCOMES: Myocardial calcification was observed in the left ventricle walls on CT examination 10 days after the admission. Four months later, the patient is still alive and with adequate daily life. LESSONS: This case indicates that this rare form of myocardial calcification may be associated with EB viral infection and rhabdomyolysis.


Assuntos
Calcinose/complicações , Infecções por Vírus Epstein-Barr/complicações , Miocardite/complicações , Rabdomiólise/complicações , Choque Cardiogênico/complicações , Adolescente , Calcinose/diagnóstico , Calcinose/terapia , Diagnóstico Diferencial , Infecções por Vírus Epstein-Barr/diagnóstico , Infecções por Vírus Epstein-Barr/terapia , Coração/diagnóstico por imagem , Humanos , Masculino , Miocardite/diagnóstico , Miocardite/terapia , Rabdomiólise/diagnóstico , Rabdomiólise/terapia , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/terapia
19.
BMJ Case Rep ; 11(1)2018 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-30567189

RESUMO

Rhabdomyolysis is characterised by muscle breakdown with release of damaging proteins that can have devastating consequences. Acute influenza infection is being increasingly recognised as an underlying aetiology. We report an unusual case of severe rhabdomyolysis with acute renal failure due to influenza A infection that improved with high-dose oseltamivir and intravenous fluids. In our case, we also noticed a temporal relation between fever spikes and subsequent increase in serum creatine kinase. The precise mechanism between the rise in temperature and creatine kinase is unclear but it could be due to direct viral invasion of myocytes or due to release of new viral progeny following replication in the myocyte.


Assuntos
Influenza Humana/diagnóstico , Rabdomiólise/diagnóstico , Adulto , Paralisia Cerebral , Creatina Quinase/sangue , Diagnóstico Diferencial , Humanos , Influenza Humana/complicações , Masculino , Rabdomiólise/sangue , Rabdomiólise/complicações , Convulsões
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