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Rhabdomyolysis and acute renal failure in children
1Department of Pediatrics, Niigata City General Hospital, 2-6-1 Shichikuyama, Niigata 950-8739, Japan. twata@hosp.niigata.niigata.jp
Insights
Acute renal failure (ARF) in children with rhabdomyolysis is linked to dehydration and severe muscle damage. Multiple organ failure and high PRISM scores increase ARF risk in pediatric rhabdomyolysis cases.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Rhabdomyolysis Pathophysiology
Background:
- Acute renal failure (ARF) is a significant complication of rhabdomyolysis in children.
- Factors influencing ARF development in pediatric rhabdomyolysis are not well understood.
Purpose of the Study:
- To identify factors contributing to ARF in pediatric rhabdomyolysis.
- To analyze clinical and laboratory data associated with ARF in this population.
Main Methods:
- Retrospective review of 18 pediatric patients with rhabdomyolysis (1991-2000).
- Comparison of clinical characteristics, laboratory data, PRISM scores, SIRS criteria, and organ dysfunction between ARF and non-ARF groups.
- Patients categorized into ARF (n=9) and non-ARF (n=9) groups.
Main Results:
- The ARF group exhibited higher incidence of dehydration, elevated myoglobin, creatinine kinase, AST, LDH, PRISM scores, SIRS criteria, and organ dysfunction.
- Lower blood pH, base excess, and urinary pH were observed in the ARF group.
- All patients in the ARF group had more than two dysfunctional organs.
Conclusions:
- Dehydration, metabolic acidosis, severe muscle damage, and multiple organ failure are associated with increased risk of ARF in pediatric rhabdomyolysis.
- Early recognition and management of these factors may be crucial for preventing ARF in children with rhabdomyolysis.
Abstract:
Acute renal failure (ARF) is an important complication of rhabdomyolysis. However, the contributing factors to the development of ARF in children with rhabdomyolysis remain obscure. The aim of this study was to clarify the factors contributing to the development of ARF in children with rhabdomyolysis. This is a retrospective review of the clinical characteristics, laboratory data, pediatric risk of mortality (PRISM) scores, the occurrence of systemic inflammatory response syndrome (SIRS) criteria, and the number of dysfunctional organs in 18 children with rhabdomyolysis seen in our hospital between 1991 and 2000. The patients were divided into an ARF group (n=9) and a non-ARF group (n=9). All patients with ARF had more than two dysfunctional organs. The incidence of dehydration, serum concentrations of myoglobin, creatinine kinase, aspartate aminotransferase, and lactate dehydrogenase, PRISM scores, and the numbers of SIRS criteria and dysfunctional organs were higher in the ARF group than the non-ARF group. The blood pH and base excess, and urinary pH were lower in the ARF group than in the non-ARF group. These results suggest that ARF is more likely to develop in the presence of dehydration, metabolic acidosis, or severe muscle damage, or with multiple organ failure in children with acute rhabdomyolysis.