Paediatric rhabdomyolysis: A UK centre's 10‐year retrospective experience

Abstract

Aims To describe the aetiologies of paediatric rhabdomyolysis and explore the medium‐term renal consequences. Methods Retrospective, single‐centre review of children with rhabdomyolysis. Results Two hundred and thirty‐two children met inclusion criteria for the analysis. Mean age at presentation was 8.4 (SD ± 5.5) years. The commonest aetiology was infection (28%), with viral myositis making up the clear majority (75%). Trauma was identified as a cause in 18% of children, seizures in 10% and immune‐mediated mechanisms in 8%. Acute kidney injury (AKI) was present in 32% of the cases overall. Children with AKI tended to be younger, with higher peak creatine kinase (CK) and active urinary sediment on urinalysis at presentation. AKI and the need for renal replacement therapy (RRT) were associated with a prolonged hospital stay (15 (interquartile range, IQR 6.5–33) vs. 2 (IQR 0–7) days). A total of 18 children and young people required RRT, with a mean duration of 7.1 ± 4.3 days. Those who received RRT were more likely to have abnormalities on urinalysis at presentation (46% vs. 5%). Over the period of the study, 9% of children died and 2% met criteria for a diagnosis of chronic kidney disease. Conclusions This large paediatric rhabdomyolysis case series provides new and unique insights into the condition. Our results highlight the common aetiologies and provide evidence of good renal recovery overall, even in the most severely affected cases. Abnormalities of urinalysis appear to be important in predicting the development of AKI and the need for RRT.

Clinical features and use of renal replacement therapy in children who visit the emergency department with benign acute childhood myositis or rhabdomyolysis who visit the emergency department

“…양성급성소아기근육염(benign acute childhood myositis, BACM)과 횡문근융해증은 공통으로 바이러스 감염, 특히 인플루엔자 감염 이후 다리의 뼈대 근육 통증 또는 보행장애를 유발한다. 하지만 신체검사에서 두 질환 모두 유사하게 이환된 뼈대 근육의 압통은 동반하지만, 관절의 부종, 발적, 운동범위 제한, 깊은 힘줄반사 저하는 동반하지 않아 서로 감별하기 어렵다 (1)(2)(3)(4)(5).…”

“…BACM은 주로 열을 동반한 감염병이 선행(先行)하는데, 명확한 치료법 없이 지지요법을 시행하고, 합병증 없이 일주일 내외에 호전된다 (1,2). 횡문근융해증도 대개 바이러스 감염이 원인이지만, 과도한 운동, 약, 대사질환 등 더 다양한 원인을 가지며, 혈청 크레아틴인산화효소가 1,000 U/L 또는 정상 상한선의 5배 이상으로 증가한다 (3,4). 횡문근융해증 환자의 5.0%-35.9%에서 다양하게 급성콩팥손상을 유발할 수 있다고 보고됐지만, 관련된 한국 소아 보고는 적었다 (6)(7)(8)(9).…”