Rhabdomyolysis-associated Acute Kidney Injury

Acute kidney injury represents one of the most severe complications of rhabdomyolysis.

We performed a prospective observational study to analyze the etiology, clinical manifestations, laboratory profile, and outcome in patients with biopsy-proven pigment-induced nephropathy between January 2017 and September 2019. History, clinical examination findings, laboratory investigations, and outcomes were recorded.

A total of 26 patients were included. Mean age was 34.81 ± 11.89 years. Mean peak serum creatinine was 6.79 ± 4.07 mg/dL. Median values of Creatine phosphokinase (CPK) and Lactate dehydrogenase (LDH) were 12500 U/L (3187, 17167.50) and 447 U/L (354.50, 908.75), respectively. Of the patients presenting with rhabdomyolysis, 12 patients (46%) had traumatic causes and 14 patients (54%) had nontraumatic causes. Nontraumatic etiology of rhabdomyolysis included seizures (1), wasp sting (1), paraphenylenediamine ingestion (2), rat killer ingestion (2), leptospirosis (2), dehydration (3), acute limb ischemia (1), Gloriosa superba ingestion (1), and prolonged immobilization (1). On renal biopsy, 16 patients had myoglobin cast nephropathy and one had immunoglobulin A deposits in addition to pigment nephropathy. Twenty (76.9%) were initiated on hemodialysis, and two patients (7.6%) were treated with peritoneal dialysis and four patients (15.5%) were treated with forced alkaline diuresis. A total of four patients died (15.4%) due to sepsis/disseminated intravascular coagulation and respiratory failure. At the mean follow-up of 6 months, two patients (7.7%) progressed to chronic kidney disease (CKD).

Rhabdomyolysis-associated acute kidney injury is an important cause of renal failure requiring renal replacement therapy. In our study, it was more common in males. Traumatic and nontraumatic causes played an equal causative role. Most of the patients recovered from AKI. Forced alkaline diuresis was found useful in nontraumatic rhabdomyolysis AKI.