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Paediatric rhabdomyolysis: A UK centre's 10-year retrospective experience
Matthew J Harmer1,2, Veronica Nijloveanu1, Eftychia Thodi1
1Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, United Kingdom.
Insights
Infections are the most common cause of paediatric rhabdomyolysis, but most children experience good kidney recovery. Urinalysis abnormalities can predict acute kidney injury (AKI) and the need for renal replacement therapy (RRT).
Area of Science:
- Pediatric Nephrology
- Rhabdomyolysis Pathophysiology
- Renal Outcomes in Children
Background:
- Rhabdomyolysis is a serious condition in children involving muscle breakdown.
- Understanding its causes and kidney impact is crucial for effective management.
Purpose of the Study:
- To identify the primary causes of rhabdomyolysis in pediatric patients.
- To assess the medium-term kidney consequences following rhabdomyolysis.
Main Methods:
- A retrospective review of 232 children diagnosed with rhabdomyolysis.
- Analysis of patient demographics, etiology, clinical presentation, and renal outcomes.
Main Results:
- Infections, particularly viral myositis, were the most frequent cause (28%).
- Acute kidney injury (AKI) occurred in 32% of cases, associated with younger age and higher creatine kinase (CK).
- Renal replacement therapy (RRT) was required for 18 children, with most showing good recovery; 2% developed chronic kidney disease.
Conclusions:
- Infections are the leading cause of pediatric rhabdomyolysis.
- Evidence suggests good overall renal recovery, even in severe cases.
- Urinalysis abnormalities are key predictors for AKI and RRT necessity.
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.
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