Prospective Study of Tetanus-Induced Acute Renal Dysfunction: Role of Adrenergic Overactivity

Diretrizes para o manejo do tétano acidental em pacientes adultos

“…(104,105) Other potential causes, such as hypovolemia, sepsis, nephrotoxic drugs and (especially) dysautonomia, are apparently more relevant. (105,106) Therefore, daily monitoring of CPK levels is not justified for the early detection of rhabdomyolysis or for the prevention of renal injury prevention. However, daily changes in of CPK levels may help to detect inappropriate muscle relaxation, allowing for adjustments in the dose of muscle relaxants.…”

Acute Renal Failure in Tetanus

“…Autonomic dysfunction, most evident in first two wk of illness, has been proposed to be the primary culprit in causing AKI [1]. No correlation was previously found between serum/urine myoglobin and ARF [1,2]. However, no patient in these studies had gross myoglobinuria, and in the study that measured serum myoglobin, levels were below renal threshold, explaining apparent non correlation [3].…”

“…Acute Kidney Injury (AKI) is a known, though not very well described, complication of tetanus; occurring in 15-39 % cases. We report AKI and myoglobinuria in a child with tetanus, and discuss pertinent issues [1,2].…”

“…AKI has been previously described as a complication of tetanus. The renal dysfunction is reported to be mild and non-oliguric [1,2]. Suggested pathophysiological mechanisms include autonomic dysfunction, and rhabdomyolysis due to uncontrolled muscle spasms.…”

“…Other contributory factors include nephrotoxic drug use, sepsis, and mechanical ventilation induced reduced cardiac output. Autonomic dysfunction, most evident in first two wk of illness, has been proposed to be the primary culprit in causing AKI [1]. No correlation was previously found between serum/urine myoglobin and ARF [1,2].…”