Rapid fall in blood myoglobin in massive rhabdomyolysis and acute renal failure

Wakabayashi, Yasuhisa; Kikuno, Takaaki; Ohwada, Takashi; Kikawada, Ryuichi

doi:10.1007/bf01707664

Cited by 67 publications

(49 citation statements)

References 7 publications

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“…The significant increases in serum and urine myoglobin and creatine kinase levels observed in the present study corresponded to those found in clinically severe cases of rhabdomyolysis [7], although the dose used was substantially lower than the muscle necrosis estimated to cause lethal rhabdomyolysis [8]. However, controversy exists on the role of myoglobin in the genesis of this syndrome [9].…”

Section: Discussionsupporting

confidence: 59%

“…The urinary myoglobin concentrations observed in the present animals corresponded to those reported in patients suffering from clinical rhabdomyolysis [7]. The decrease in the high serum myoglobin concentrations cannot be explained solely by increased urinary myoglobin output, other mechanisms may play a role, and may include renal metabolism [7], and myoglobin reabsorption in the glomeruli [24], as well as intestinal sequestration of myoglobin [25].…”

supporting

confidence: 72%

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Central Hemodynamic Changes in Experimental Muscle Crush Injury in Pigs

Rawlins

Gullichsen²,

Kuttila³

et al. 1999

Eur Surg Res

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To investigate central and pulmonary hemodynamics in a standardized normovolemic experimental muscle injury model, 8 anesthetized and mechanically ventilated test pigs were intracavally infused with 100 ml of autologous muscle extract over a period of 100 min; 8 control pigs received Ringer’s solution. The cardiac index decreased 20% and the heart rate decreased 10% within 30 min of starting the infusion in the muscle extract group and remained depressed. Mean arterial pressure increased significantly in both groups. The pulmonary capillary wedge pressure and central venous pressure remained relatively unchanged during the 5-hour study. A 2-fold increase in mean pulmonary arterial pressure and a nearly 4-fold increase in the pulmonary vascular resistance index was seen in the muscle extract infusion group, which however returned to normal. Arterial hemoglobin concentration and systemic vascular resistance index remained fairly stationary in both groups. Immediate significant decreases in both arterial oxygen saturation and arterial oxygen tension were observed in the muscle extract group, however both variables recovered towards the end of the experiment. A slight increase in arterial blood pH value was noted during the experiment. In conclusion, autologous muscle extract infusion causes decreases in heart rate and cardiac index, as well as a significant increase in pulmonary vascular tone and systemic hypoxemia, emphasizing the detrimental effects of skeletal muscle injury following severe trauma.

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Section: Discussionsupporting

confidence: 59%

supporting

confidence: 72%

Central Hemodynamic Changes in Experimental Muscle Crush Injury in Pigs

Rawlins

Gullichsen²,

Kuttila³

et al. 1999

Eur Surg Res

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“…Pools do not equilibrate rapidly, such that effective blood purification will substantially reduce plasma myoglobin concentration [13,14]. …”

Section: Introductionmentioning

confidence: 99%

High Cut-Off Renal Replacement Therapy for Removal of Myoglobin in Severe Rhabdomyolysis and Acute Kidney Injury: A Case Series

et al. 2013

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Background/Aim: Rhabdomyolysis is associated with the release of myoglobin into the circulation, promoting acute kidney injury (AKI). In severe rhabdomyolysis, dialysis-dependent AKI doubles mortality. Standard blood purification techniques have limited efficacy in removing myoglobin. We describe high cut-off (HCO) renal replacement therapy (RRT) as a novel approach for extracorporeal elimination of myoglobin in rhabdomyolysis-associated AKI. Methods: With an in vivo molecular cut-off at 45 kDa, HCO filters are effective in removing myoglobin (17.8 kDa). Clearances across standard and HCO filters using continuous or intermittent RRT are reviewed in a case series of 11 patients with severe rhabdomyolysis and dialysis-dependent AKI. Results: Median myoglobin clearance across standard high-flux filters was 3.3 (interquartile range 2.3–3.9) ml/min for sustained low-efficiency daily dialysis (SLEDD) batch hemodialysis (HD) and 3.7 (2.9–6.7) ml/min for conventional HD. Respective clearances using HCO filters (membrane surface area: 1.1 m²) were 21.7 (20.3–26.1) ml/min (SLEDD) and 44.2 (41.3–47.0) ml/min (HD). Corrected for filter size, up to 20-fold higher clearances were obtained using HCO filters, resulting in profound and sustained reduction of plasma myoglobin concentration. Conclusions: As a novel approach, HCO RRT allows for rapid and effective removal of myoglobin from the circulation. In light of the pathogenic role in AKI, reducing exposure of the kidney to myoglobin may improve renal recovery and patient outcome. Our data pave the way for prospective trials, addressing this issue.

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“…In contrast, there is a very weak correlation between peak CK values and peak serum creatinine (1). Evidence that serum myoglobin falls quickly when muscle damage ceases, apparently independently of renal function, suggests a potential clinical benefit from analyte measurement in cases where renal replacement therapy is involved (8). Whether myoglobin clearance could be used as an early indicator of renal outcome in muscle injury needs investigation (9).…”

mentioning

confidence: 99%