Non-traumatic and non-drug-induced rhabdomyolysis

Kolovou, Genovefa; Cokkinos, Philip; Bilianou, Helen; Kolovou, Vana; Katsiki, Niki; Mavrogeni, Sophie

doi:10.5114/amsad.2019.90152

Cited by 7 publications

(4 citation statements)

References 147 publications

(171 reference statements)

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“…The most common cause is traumatic damage of the muscles, for example in patients after multiple traumas [ 2 ]. However, the clinical picture can also occur as part of severe sepsis and due to drug side effects [ 3 ]. Ultimately, many intensive care unit (ICU) patients are affected.…”

Section: Introductionmentioning

confidence: 99%

Blood purification with a cytokine adsorber for the elimination of myoglobin in critically ill patients with severe rhabdomyolysis

et al. 2021

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Background Rhabdomyolysis is frequently occurring in critically ill patients, resulting in a high risk of acute kidney injury (AKI) and potentially permanent kidney damage due to increased myoglobin levels. The extracorporeal elimination of myoglobin might be an approach to prevent AKI, but its molecular weight of 17 kDa complicates an elimination with conventional dialysis membranes. Question of interest is, if myoglobin can be successfully eliminated with the cytokine adsorber Cytosorb® (CS) integrated in a high-flux dialysis system. Methods Patients were included between 10/2014 and 05/2020 in the study population if they had an anuric renal failure with the need of renal replacement therapy, if CS therapy was longer than 90 min and if myoglobin level was > 5.000 ng/ml before treatment. The measurement times of the laboratory values were: d-1 = 24–36 h before CS, d0 = shortly before starting CS and d1 = 12–24 h after starting CS treatment. Statistical analysis were performed with Spearman’s correlation coefficient, Wilcoxon test with associated samples and linear regression analysis. Results Forty-three patients were included in the evaluation (median age: 56 years, 77% male patients, 32.6% ECMO therapy, median SAPS II: 80 points and in-hospital mortality: 67%). There was a significant equilateral correlation between creatine kinase (CK) and myoglobin at all measurement points. Furthermore, there was a significant reduction of myoglobin (p = 0.03, 95% confidence interval (CI): − 9030, − 908 ng/ml) during CS treatment, with a median relative reduction of 29%. A higher median reduction of 38% was seen in patients without ongoing rhabdomyolysis (CK decreased during CS treatment, n = 21). In contrast, myoglobin levels did not relevantly change in patients with increasing CK and therefore ongoing rhabdomyolysis (n = 22, median relative reduction 4%). Moreover, there was no significant difference in myoglobin elimination in patients with and without ECMO therapy. Conclusion Blood purification with Cytosorb® during high-flux dialysis led to a significant reduction of myoglobin in patients with severe rhabdomyolysis. The effect might be obscured by sustained rhabdomyolysis, which was seen in patients with rising CK during treatment. Prospective clinical trials would be useful in investigating its benefits in avoiding permanent kidney damage.

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Section: Introductionmentioning

confidence: 99%

Blood purification with a cytokine adsorber for the elimination of myoglobin in critically ill patients with severe rhabdomyolysis

et al. 2021

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“…Ion release can result in transient or prolonged hyperkalaemia, hyperphosphataemia and hypocalcaemia, which can overwhelm homoeostatic regulatory processes, and be exacerbated by AKI. 10 The management of these electrolyte disturbances differs little from the management in other settings, as in the patient above.…”

Section: Electrolyte Disturbancementioning

confidence: 99%

Rhabdomyolysis: An evidence-based approach

Burgess

2021

Journal of the Intensive Care Society

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A 76-year-old lady was found on the floor following a fall at home. She was uninjured, but unable to get up, and had been lying on the floor for roughly 18 hours before her son arrived. She had been unwell for the past 3 days with a cough and shortness of breath. She had a past medical history of diabetes, hypertension, hypercholesterolaemia and atrial fibrillation (AF). On examination, she was alert but distressed, clinically dehydrated, febrile and tachycardic. She was treated for community acquired pneumonia with co-amoxiclav and was fluid resuscitated with Hartmann’s solution. Her hyperkalaemia was treated with 50 mL of 50% glucose containing 10 units of rapid-acting insulin. Her creatinine kinase (CK) on admission was 200,000, and she had an acute kidney injury (AKI). Urine dipstick was positive for blood. However, her renal function continued to deteriorate over the succeeding 48 h, when she required renal replacement therapy (RRT) due to fluid overload and anuria.

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“…Рабдомиолиз (РМ) -это клинико-лабораторный синдром, в основе которого лежит повреждение поперечнополосатых мышц (миоцитов) различной этиологии с освобождением внутриклеточного содержимого в системный кровоток [1,2].…”

Section: The Early Use Of Selective Hemoadsorption Based On a Hyper-c...unclassified

The Early Use of Selective Hemoadsorption Based on a Hyper-Crosslinked Styrene-Divinylbenzene Copolymer in Patients with Toxic Rhabdomyolysis Complicated by Acute Kidney Injury (Multicenter Randomized Clinical Trial)

Masolitin

Проценко

Tyurin³

et al. 2022

Obŝaâ reanimatologiâ

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Rhabdomyolysis (RM) is a clinical and laboratory syndrome with the underlying destruction of myocytes and the release of intracellular debris into the systemic circulation. In more than 55% of cases, RM is complicated by acute kidney injury (AKI), which necessitates various methods of extracorporeal detoxification and currently is a controversial issue.Aim: to improve the results of treatment of patients with RM of toxic origin complicated by AKI by using early selective hemoadsorption (SH).Material and methods. The study included 36 patients divided into 2 groups. Group 1 included 24 patients who received standard therapy and hemodiafiltration (HDF) as a life-saving intervention. Group 2 comprised 12 patients who underwent early SH to prevent the progression of AKI. We performed a comparative analysis of clinical and laboratory parameters and treatment outcomes in the groups.Results. The use of SH was associated with reduced level of myoglobin on day5 of therapy from 384.1 to 112.4 gg/l (70.7%) vs 335.15 to 219.1 gg/l (34.6%) reduction in the conservative therapy group. By day 7, this parameter was 18.8 (95.1%) and 142.4 (57.5%), respectively (7=0.012). The level of cystatin-C decreased on day 5 from 17.3 to 3.2 mg/l (81.5%) in group 2 and from 14.9 to 11.7 mg/l (21.5%) in group 1. By day 7, this parameter decreased to 2.5 (85.6%) and 14.1 (5.3%) mg/l, respectively (7=0.001). The length of ICU stay in group 2 was 7 (6; 9) days, while in the conservative therapy group it was 12 (7; 13) days (7=0.04). The hospital stay was 12 (10; 16) and 22 (14,5; 24,5) days, respectively (7=0.028).Conclusion. The early use of SH in the intensive therapy helped decrease the levels of markers of endogenous intoxication, AKI severity, improve the filtration capacity of the kidneys, and reduced the length of stay in the ICU and hospital.

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Non-traumatic and non-drug-induced rhabdomyolysis

Cited by 7 publications

References 147 publications

Blood purification with a cytokine adsorber for the elimination of myoglobin in critically ill patients with severe rhabdomyolysis

Blood purification with a cytokine adsorber for the elimination of myoglobin in critically ill patients with severe rhabdomyolysis

Rhabdomyolysis: An evidence-based approach

The Early Use of Selective Hemoadsorption Based on a Hyper-Crosslinked Styrene-Divinylbenzene Copolymer in Patients with Toxic Rhabdomyolysis Complicated by Acute Kidney Injury (Multicenter Randomized Clinical Trial)

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