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Acute pediatric rhabdomyolysis: causes and rates of renal failure
Rebekah Mannix1, Mei Lin Tan, Robert Wright
1Division of Emergency Medicine, Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA. rebekah.mannix@childrens.harvard.edu
Insights
Pediatric rhabdomyolysis, a condition causing muscle breakdown, has different causes and a lower risk of acute kidney injury in children compared to adults. Viral myositis is a common cause in children.
Area of Science:
- Pediatric Nephrology
- Rhabdomyolysis Pathophysiology
- Acute Kidney Injury
Background:
- Rhabdomyolysis involves muscle breakdown, leading to potential kidney damage.
- Understanding pediatric rhabdomyolysis is crucial for timely diagnosis and management.
- Comparing pediatric and adult cases helps elucidate disease-specific factors.
Purpose of the Study:
- Compare pediatric rhabdomyolysis causes, presentation, and acute renal failure (ARF) prevalence with adult data.
- Identify predictors of ARF in pediatric rhabdomyolysis.
- Examine ARF's relationship with fluid and bicarbonate administration.
Main Methods:
- Retrospective chart review of pediatric patients with elevated creatinine kinase (>1000 IU/L).
- Inclusion criteria: tertiary pediatric hospital ED treatment (1993-2003).
- Regression models used to determine predictors and associations.
Main Results:
- 191 pediatric patients studied; common causes: viral myositis (38%), trauma (26%).
- Nine patients developed acute renal failure (ARF).
- Higher initial creatinine kinase and fluid administration rates correlated with higher maximal creatinine levels; urinary heme dipstick results of ≥2+ were associated with ARF.
Conclusions:
- Causes of pediatric rhabdomyolysis differ from adult cases.
- The risk of acute renal failure in children with rhabdomyolysis is significantly lower than in adults.
- Higher creatinine kinase levels and specific urinary findings may indicate increased ARF risk.
Objectives:
The goals were to (1) compare the causes, clinical presentation, and prevalence of acute renal failure in pediatric rhabdomyolysis with the published data for adults; (2) determine predictors of acute renal failure in pediatric patients with rhabdomyolysis; and (3) explore the relationship of acute renal failure with treatment modalities such as fluid and bicarbonate administration.
Methods:
We performed a retrospective chart review to identify patients with creatinine kinase levels of > 1000 IU/L who were treated in the emergency department of a tertiary pediatric hospital between 1993 and 2003, and we constructed regression models.
Results:
Two hundred ten patients were studied. One hundred ninety-one patients met study eligibility (128 male and 63 female), with a median age of 11 years. The most common documented symptoms were muscle pain (45%), fever (40%), and symptoms of viral infection (39%). The most common causes of pediatric rhabdomyolysis were viral myositis (38%), trauma (26%), and connective tissue disease (5%). Six of 37 patients with creatinine kinase levels of > or = 6000 IU/L had previously undiagnosed dermatomyositis or hereditary metabolic disease, compared with 10 of 154 patients with creatinine kinase levels of 1000 to 5999 IU/L. Nine of 191 patients developed acute renal failure. None of 99 patients with initial urinary heme dipstick results of < 2+ developed acute renal failure, compared with 9 of 44 patients with urinary heme dipstick results of > or = 2+. Higher initial creatinine kinase levels and higher fluid administration rates were associated with higher maximal creatinine levels.
Conclusions:
The cause of acute pediatric rhabdomyolysis is different from that of adult rhabdomyolysis. The risk of acute renal failure in children is much less than the risk reported for adults.
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