Severe falciparum malaria with dengue coinfection complicated by rhabdomyolysis and acute kidney injury: an unusual case with myoglobinemia, myoglobinuria but normal serum creatine kinase

The patient is a 75-year-old man who presented with right arm pain, edema, and erythema. The same manifestations appeared in the other arm 3 weeks later. He also developed fever, acute kidney injury, anemia, and truncal edema. Initial extensive evaluation was unrevealing. He was noted to have elevated creatine kinase, and a diagnostic muscle biopsy lead to diagnosis of inflammatory myositis. He improved with corticosteroids.

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How to do it: investigate exertional rhabdomyolysis (or not)

Practical Neurology ◽

10.1136/practneurol-2018-002008 ◽

2018 ◽

Vol 19 (1) ◽

pp. 43-48 ◽

Cited By ~ 7

Author(s):

Peter M Fernandes ◽

Richard J Davenport

Keyword(s):

Acute Kidney Injury ◽

Creatine Kinase ◽

Kidney Injury ◽

Underlying Disease ◽

Serum Creatine Kinase ◽

Muscle Disease ◽

Initial Presentation ◽

Organ Support ◽

Exertional Rhabdomyolysis ◽

Substantial Rise

Rhabdomyolysis is the combination of symptoms (myalgia, weakness and muscle swelling) and a substantial rise in serum creatine kinase (CK) >50 000 IU/L; there are many causes, but here we specifically address exertional rhabdomyolysis. The consequences of this condition can be severe, including acute kidney injury and requirement for higher level care with organ support. Most patients have ‘physiological’ exertional rhabdomyolysis with no underlying disease; they do not need investigation and should be advised to return to normal activities in a graded fashion. Rarely, exertional rhabdomyolysis may be the initial presentation of underlying muscle disease, and we review how to identify this much smaller group of patients, who do require investigation.

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The value of serum creatine kinase in predicting the risk of rhabdomyolysis-induced acute kidney injury: a systematic review and meta-analysis

Clinical and Experimental Nephrology ◽

10.1007/s10157-015-1204-1 ◽

2016 ◽

Vol 20 (2) ◽

pp. 153-161 ◽

Cited By ~ 26

Author(s):

Saeed Safari ◽

Mahmoud Yousefifard ◽

Behrooz Hashemi ◽

Alireza Baratloo ◽

Mohammad Mehdi Forouzanfar ◽

...

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Creatine Kinase ◽

Meta Analysis ◽

Kidney Injury ◽

Serum Creatine Kinase

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Severe falciparum malaria treated with artesunate complicated by delayed onset haemolysis and acute kidney injury

Malaria Journal ◽

10.1186/s12936-015-0760-x ◽

2015 ◽

Vol 14 (1) ◽

Cited By ~ 14

Author(s):

Katherine Plewes ◽

Md Shafiul Haider ◽

Hugh W F Kingston ◽

Tsin W Yeo ◽

Aniruddha Ghose ◽

...

Keyword(s):

Acute Kidney Injury ◽

Falciparum Malaria ◽

Kidney Injury ◽

Delayed Onset ◽

Severe Falciparum Malaria

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Relationship of body mass index, serum creatine kinase, and acute kidney injury after severe trauma

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000002714 ◽

2020 ◽

Vol 89 (1) ◽

pp. 179-185

Author(s):

Charles R. Vasquez ◽

Thomas DiSanto ◽

John P. Reilly ◽

Caitlin M. Forker ◽

Daniel N. Holena ◽

...

Keyword(s):

Body Mass Index ◽

Acute Kidney Injury ◽

Creatine Kinase ◽

Body Mass ◽

Kidney Injury ◽

Severe Trauma ◽

Serum Creatine Kinase ◽

Relationship Of

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Serum Creatine Kinase Levels are not Associated with an Increased Need for Continuous Renal Replacement Therapy in Patients with Acute Kidney Injury Following Rhabdomyolysis

10.21203/rs.3.rs-1049043/v1 ◽

2021 ◽

Author(s):

Luniu Xiao ◽

Xiao Ran ◽

Yanxia Zhong ◽

Yue Le ◽

Shusheng Li

Keyword(s):

Acute Kidney Injury ◽

Creatine Kinase ◽

Renal Replacement Therapy ◽

Length Of Stay ◽

Kidney Injury ◽

Hospital Length ◽

Serum Creatine Kinase ◽

Hospital Length Of Stay ◽

Renal Functions ◽

Experimental Group

Abstract BackgroudRhabdomyolysis is a syndrome caused by the breakdown and necrosis of skeletal muscle tissues. As a result, there is leakage of various intercellular myocyte contents into the circulating blood stream. Severe rhabdomyolysis can lead to acute kidney injury (AKI) and cause potentially permanent kidney damage. Previous studies have reported benefit from continuous renal replacement therapy (CRRT) for rhabdomyolysis-associated AKI. For patients with AKI, the termination of CRRT often depends on the patient’s renal functions. Here, we asked whether serum creatine kinase (CK) levels should be considered for CRRT termination in patients with AKI following rhabdomyolysis.MethodsWe compared different CK levels in patients after CRRT termination and we observed the correlation between CK levels and clinical outcomes. For a retrospective study, we collected 86 cases with confirmed rhabdomyolysis-associated AKI, who had received CRRT from January 1st of 2012 to December 31th of 2020 in Tongji Hospital. Patients’ renal functions were assessed within 24 hours of intermission, and patients with urine output ≥ 1,000 mL and serum creatinine ≤ 265 umol/L were considered for CRRT termination. Following CRRT termination, patients were divided into a CK > 5,000 U/L group (experimental group) and a CK < 5,000 U/L group (control group). The outcomes, such as in-hospital mortality and in-hospital length of stay, were compared between two groups.ResultsThirty-three (38.37%) patients were classified as having CK > 5,000 U/L, while 53 (61.63%) were categorized as having CK < 5,000 U/L. The majority of laboratory examinations were comparable between the two groups on admission. The higher CK levels, as well as worse renal functions, predicted the necessity of CRRT continuation for patients. After CRRT termination, the in-hospital mortality (27.27% vs 22.64, p = 0.389) and Multiple Organ Dysfunction Syndrome (MODS) incidence (51.52% vs 49.06%, p = 0.064) were similar between two groups, while the experimental group showed a significantly shorter in-hospital length of stay (11.88 ± 1.469 vs 16.42 ± 1.290, p = 0.026) and Intensive Care Unit (ICU) length of stay (7.545 ± 0.866 vs 10.11 ± 0.793, p = 0.038).ConclusionCRRT termination may be independent of s the CK levels for patients with rhabdomyolysis-associated acute kidney injure, providing their renal functions have recovered to an appropriate level. Prospective clinical trials would be needed to more thoroughly investigate the optimal CK range that could be used as a gauge to prevent recurrence of renal impairments after treatments.

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Rhabdomyolysis

10.2310/7ccsp.8301 ◽

2016 ◽

Author(s):

Anthony Baldea

Keyword(s):

Skeletal Muscle ◽

Acute Kidney Injury ◽

Creatine Kinase ◽

Compartment Syndrome ◽

Kidney Injury ◽

Serum Creatine Kinase ◽

Intravascular Volume ◽

Adequate Hydration ◽

Early Use ◽

High Level

Rhabdomyolysis is a condition that results from the breakdown of skeletal muscle. The etiologies can be broken down into three main categories of causes: traumatic, atraumatic exertional, and atraumatic nonexertional. Patients with rhabdomyolysis often present with myalgia and are found to have myoglobinuria with elevations in serum creatine kinase levels. The mainstay in therapy is focused on restoration of intravascular volume with large-volume fluid resuscitation using isotonic fluids. Adequate hydration is necessary to prevent the potential complications of rhabdomyolysis, including the development of acute kidney injury. Practitioners should maintain a high level of suspicion of compartment syndrome in patients with rhabdomyolysis. If extremity compartment syndrome is diagnosed, prompt decompressive fasciotomies should be performed to preserve muscle and nerve viability. The early use of renal replacement therapy in patients with rhabdomyolysis has been described in the literature and may represent another modality of therapy to prevent the adverse sequelae of rhabdomyolysis. Key words: acute kidney injury, compartment syndrome, creatine kinase, disseminated intravascular coagulation, rhabdomyolysis

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Identifying Prognostic Factors of Severe Metabolic Acidosis and Acute Kidney Injury in African Children with Severe Falciparum Malaria: A Secondary Analysis of A Randomised Trial

10.21203/rs.3.rs-148298/v1 ◽

2021 ◽

Author(s):

Grace Wezi Mzumara ◽

Stije Stije Leopold ◽

Kevin Marsh ◽

Arjen Dondorp ◽

Eric Ohuma ◽

...

Keyword(s):

Acute Kidney Injury ◽

Prognostic Factors ◽

Metabolic Acidosis ◽

Falciparum Malaria ◽

Kidney Injury ◽

Severe Anaemia ◽

Severe Metabolic Acidosis ◽

Prognostic Features ◽

African Children ◽

Severe Falciparum Malaria

Abstract IntroductionSevere metabolic acidosis and acute kidney injury are major causes of mortality in children with severe malaria but are often underdiagnosed in low resource settings. MethodsWe conducted a retrospective analysis of the ‘Artesunate vs Quinine in the treatment of severe falciparum malaria in African children’ (AQUAMAT) trial to identify clinical features of severe metabolic acidosis and acute kidney injury in 5425 children from nine African countries. Separate models were fitted for acute kidney injury and severe metabolic acidosis. Separate univariable and multivariable logistic regression were performed to identify prognostic factors for severe metabolic acidosis (SMA) and acute kidney injury (AKI). Both analyses adjusted for the trial arm. A forward selection approach was used for model building of the logistic models and a threshold of 5% statistical significance was used for inclusion of variables into the final logistic model. Model performance was assessed through calibration, discrimination, and internal validation with bootstrapping. ResultsThere were 2296 children identified with Severe metabolic acidosis and 1110 with Acute Kidney Injury. Prognostic features of SMA among them were: deep breathing (OR: 5.41, CI: 4.26 – 6.89), hypoglycaemia (OR: 5.22, CI: 3.80 – 7.18), AKI (OR: 3.99, CI: 3.30 – 4.81), coma ( OR: 1.79 CI: 1.36 – 2.35), respiratory distress (OR: 1.49, CI: 1.21 – 1.83), prostration (OR: 1.64 CI: 1.30 – 2.03) and severe anaemia (OR: 1.40, CI: 1.11 – 1.77). Features associated with AKI were; older children(OR: 1.20, CI: 1.15 – 1.25), coma (2.47, CI: 1.78 – 3.42), Prostration (OR: 1.52 CI: 1.14 – 2.02), decompensated shock (OR: 1.74, CI: 1.15 – 2.63), black water fever (CI: 1.81. CI: 1.22 – 2.69), jaundice (OR: 3.31 CI: 2.01 – 5.47), SMA (OR: 4.02 CI:3.30 – 4.89), mild anaemia (OR: 1.36, CI: 1.05 – 1.76), severe anaemia (OR: 1.48, CI: 1.11 – 1.96), hypoglycaemia (OR: 2.02, CI: 1.58 – 2.59), hypernatremia (OR: 5.74, CI: 2.69 – 12.26) and hyperkalaemia (OR: 5.31. CI: 4.15 – 6.80). ConclusionClinical and laboratory parameters representing contributors and consequences of severe metabolic acidosis and acute kidney injury were independently associated with these outcomes. The model can be useful for identifying patients at high risk of these complications where laboratory assessments are not routinely available.

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