Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
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Continuous Renal Replacement Therapy in a 4-year-old Child with Rhabdomyolysis Following Parainfluenza Virus Infection and Hyperammonemia due to Isovaleric Acidemia

Parainfluenza virus 감염 후 발생한 횡문근융해증과 isovaleric acidemia로 인한 고암모니아혈증을 가진 소아에서의 지속적 신대체요법

  • Park, Se Jin (Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine) ;
  • Cho, Soo Yeon (Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine) ;
  • Pai, Ki Soo (Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine) ;
  • Shin, Jae Il (Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine)
  • 박세진 (아주대학교 의과대학 소아청소년과학교실, 아주대병원 소아청소년과) ;
  • 조수연 (아주대학교 의과대학 소아청소년과학교실, 아주대병원 소아청소년과) ;
  • 배기수 (아주대학교 의과대학 소아청소년과학교실, 아주대병원 소아청소년과) ;
  • 신재일 (연세대학교 의과대학 소아과학교실, 세브란스 어린이병원 소아청소년과)
  • Received : 2013.09.14
  • Accepted : 2013.10.02
  • Published : 2013.10.31
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Abstract

Parainfluenza virus infection is one of the causes of fatal rhabdomyolysis. Rhabdomyolysis can be aggravated by mitochondrial fatty acid ${\beta}$-oxidation disorders during prolonged periods of fasting. Moreover, in patients with late-onset isovaleric acidemia, hyperammonemia may occur following catabolic stress. In the present report, we describe a case of a 4-year-old boy with parainfluenza virus infection and late-onset isovaleric acidemia that rapidly progressed to coma, seizures, and cardiorespiratory collapse. His serum ammonia and creatinine kinase (CK) levels were $385{\mu}Mol/L$ and 23,707 IU/L, respectively. Continuous renal replacement therapy (CRRT) was initiated using continuous venovenous hemodiafiltration, after which the ammonia and CK levels returned to normal. Thus, we recommend the immediate initiation of CRRT in the management of patients with life-threatening rhabdomyolysis and hyperammonemia.

Parainfluenza virus 감염은 횡문근융해증의 하나의 원인이 될 수 있다. 횡문근융해증은 지속된 금식기간동안 미토콘드리아 지방산 ${\beta}$-oxidation 장애에 의해 악화될 수 있다. 또한 후기 발생 isovaleric 산증을 가진 환아들에게서 고암모니아혈증이 이화작용을 일으키는 상태 후 발생할 수 있다. 본 케이스는 parainfluenza virus 감염과 후기 발생 isovaleric 산증을 가진 4세 남아가 혼수, 경련 및 심호흡 부전으로 빠르게 진행했던 경우이다. 초기 암모니아와 creatinine kinase는 각각 $385{\mu}Mol/L$과 23,707 IU/L 이었으나 지속적 신대체요법 시행 후 암모니아와 creatinine kinase 수치는 정상으로 돌아왔다. 그러므로 생명을 위협하는 횡문근융해증과 고암모니아혈증을 가진 환아들의 치료에 있어서 즉각적인 지속적 신대체요법의 사용을 권하는 바이다.

Keywords

References

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