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Published on: February 2, 2021
Extracorporeal Blood Purification (HA-380) in Rhabdomyolysis-Induced Acute Kidney Injury: A Successful Outcome
Marisa Cunha1, Sílvia Sousa1, Ricardo Marinho1
1Intensive Care Unit, Unidade Local de Saúde de Santo António, Oporto, Portugal.
Background:
Rhabdomyolysis (RM) is a multifactorial syndrome characterised by skeletal muscle breakdown and release of intracellular components, notably myoglobin, into the circulation. Elevated myoglobin levels are a major contributor to acute kidney injury (AKI), yet conventional renal replacement therapies (RRT) are limited in their ability to clear myoglobin due to its molecular size.
Case Description:
We present a case of a woman who developed severe RM-induced AKI secondary to necrotising myopathy. Despite initial fluid and diuretic therapy, her condition progressed to oliguric AKI. She was admitted to intensive care unit and prolonged intermittent RRT was then initiated. Due to markedly elevated myoglobin levels, a haemoadsorption device (HA-380 hemoperfusion cartridge) was added to the RRT circuit, leading to significant laboratory and clinical improvement.
Discussion:
Severe RM frequently leads to AKI due to myoglobin-induced tubular damage. While conventional RRT removes myoglobin poorly, haemoadsorption using the HA-380 cartridge effectively reduced plasma myoglobin and creatine phosphokinase levels in our patient, supporting early implementation to enhance renal recovery. Evidence from case reports and recent studies suggests safety and efficacy, but clinical outcomes remain incompletely defined, and optimal therapy timing, thresholds and duration require further investigation.
Conclusion:
This case highlights the potential utility of extracorporeal adsorption therapy as an adjunct to RRT for effective myoglobin removal in severe RM-induced AKI. Early implementation of this strategy may enhance renal recovery and improve outcomes, though clinical evidence remains limited.
Learning Points:
Rhabdomyolysis is characterised by muscle breakdown with release of creatine kinase and myoglobin into the bloodstream. Elevated myoglobin levels are a major contributor to acute kidney injury and potentially permanent kidney damage.Conventional renal replacement therapies alone have limited the ability to remove myoglobin due to its molecular size. Timely haemoadsorption may offer a practical solution, enhancing myoglobin clearance and improving outcomes.Prospective studies are needed to establish the optimal use and efficacy of haemoadsorption in rhabdomyolysis-induced acute kidney injury.
Insights
Haemoadsorption effectively cleared myoglobin in a severe case of rhabdomyolysis-induced acute kidney injury. This extracorporeal therapy, when added to renal replacement therapy, showed significant improvement, suggesting its potential for enhancing kidney recovery.
Area of Science:
- Nephrology
- Intensive Care Medicine
- Toxicology
Background:
- Rhabdomyolysis involves skeletal muscle breakdown, releasing myoglobin into circulation.
- Elevated myoglobin is a primary cause of acute kidney injury (AKI).
- Conventional renal replacement therapies (RRT) are inefficient at clearing large molecules like myoglobin.
Purpose of the Study:
- To present a case of severe rhabdomyolysis-induced AKI managed with haemoadsorption.
- To evaluate the efficacy of haemoadsorption as an adjunct to RRT for myoglobin removal.
Main Methods:
- A patient with severe rhabdomyolysis and AKI was treated with prolonged intermittent RRT.
- A haemoadsorption device (HA-380 cartridge) was integrated into the RRT circuit.
- Plasma levels of myoglobin and creatine phosphokinase were monitored.
Main Results:
- The addition of haemoadsorption led to significant reductions in myoglobin and creatine phosphokinase levels.
- The patient experienced notable laboratory and clinical improvement.
- Haemoadsorption facilitated effective myoglobin clearance, which is poorly achieved by RRT alone.
Conclusions:
- Extracorporeal adsorption therapy, specifically haemoadsorption, can be a valuable adjunct to RRT in managing severe rhabdomyolysis-induced AKI.
- Early implementation of haemoadsorption may improve renal recovery and patient outcomes.
- Further prospective studies are needed to define optimal protocols for haemoadsorption in this setting.
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Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...