Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Acute kidney injury in pediatric patients with rhabdomyolysis

  • Lim, Young Shin (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Cho, Heeyeon (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Sang Taek (Department of Pediatrics, Gyeongsang National University Changwon Hospital) ;
  • Lee, Yeonhee (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2017.09.19
  • Accepted : 2017.10.17
  • Published : 2018.03.15
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Abstract

Purpose: This study aimed to evaluate the clinical findings in pediatric rhabdomyolysis and the predictive factors for acute kidney injury (AKI) in Korean children. Methods: Medical records of 39 Korean children, who were newly diagnosed with rhabdomyolysis from January 2008 to December 2015, were retrospectively analyzed. The diagnosis was made from the medical history, elevated serum creatinine kinase level >1,000 IU/L, and plasma myoglobin level >150 ng/mL. Patients with muscular dystrophy and myocardial infarction were excluded. Results: The median patient age at diagnosis was 14.0 years (range, 3-18 years), and the male to female ratio was 2.5. The most common presenting symptom was myalgia (n=25, 64.1%), and 14 patients (35.9%) had rhabdomyolysis-induced AKI. Eighteen patients (46.2%) had underlying diseases, such as epilepsy and psychotic disorders. Ten of these patients showed rhabdomyolysis-induced AKI. The common causes of rhabdomyolysis were infection (n=12, 30.7%), exercise (n=9, 23.1%), and trauma (n=8, 20.5%). There was no difference in the distribution of etiology between AKI and non-AKI groups. Five patients in the AKI group showed complete recovery of renal function after stopping renal replacement therapy. The median length of hospitalization was 7.0 days, and no mortality was reported. Compared with the non-AKI group, the AKI group showed higher levels of peak creatinine kinase and myoglobin, without statistical significance. Conclusion: The clinical characteristics of pediatric rhabdomyolysis differ from those observed in adult patients. Children with underlying diseases are more vulnerable to rhabdomyolysis-induced AKI. AKI more likely develops in the presence of a high degree of albuminuria.

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References

  1. Warren JD, Blumbergs PC, Thompson PD. Rhabdomyolysis: a review. Muscle Nerve 2002;25:332-47. https://doi.org/10.1002/mus.10053
  2. Allison RC, Bedsole DL. The other medical causes of rhabdomyolysis. Am J Med Sci 2003;326:79-88. https://doi.org/10.1097/00000441-200308000-00005
  3. Melli G, Chaudhry V, Cornblath DR. Rhabdomyolysis: an evaluation of 475 hospitalized patients. Medicine (Baltimore) 2005;84:377-85. https://doi.org/10.1097/01.md.0000188565.48918.41
  4. Giannoglou GD, Chatzizisis YS, Misirli G. The syndrome of rhabdomyolysis: pathophysiology and diagnosis. Eur J Intern Med 2007;18:90-100. https://doi.org/10.1016/j.ejim.2006.09.020
  5. Gabow PA, Kaehny WD, Kelleher SP. The spectrum of rhabdomyolysis. Medicine (Baltimore) 1982;61:141-52. https://doi.org/10.1097/00005792-198205000-00002
  6. Sauret JM, Marinides G, Wang GK. Rhabdomyolysis. Am Fam Physician 2002;65:907-12.
  7. Bagley WH, Yang H, Shah KH. Rhabdomyolysis. Intern Emerg Med 2007;2:210-8. https://doi.org/10.1007/s11739-007-0060-8
  8. Bosch X, Poch E, Grau JM. Rhabdomyolysis and acute kidney injury. N Engl J Med 2009;361:62-72. https://doi.org/10.1056/NEJMra0801327
  9. Ward MM. Factors predictive of acute renal failure in rhabdomyolysis. Arch Intern Med 1988;148:1553-7. https://doi.org/10.1001/archinte.1988.00380070059015
  10. Elsayed EF, Reilly RF. Rhabdomyolysis: a review, with emphasis on the pediatric population. Pediatr Nephrol 2010;25:7-18. https://doi.org/10.1007/s00467-009-1223-9
  11. Kellum JA, Lameire N; KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care 2013;17:204. https://doi.org/10.1186/cc11454
  12. Schwartz GJ, Feld LG, Langford DJ. A simple estimate of glomerular filtration rate in full-term infants during the first year of life. J Pediatr 1984;104:849-54. https://doi.org/10.1016/S0022-3476(84)80479-5
  13. Schwartz GJ, Gauthier B. A simple estimate of glomerular filtration rate in adolescent boys. J Pediatr 1985;106:522-6. https://doi.org/10.1016/S0022-3476(85)80697-1
  14. Kim HY, Choi SO, Shin SJ, Kim YK, Han BG, Park SJ, et al. Analysis of 250 cases of rhabdomyolysis. J Korean Soc Nephrol 1994;13:810-7.
  15. Wu CT, Huang JL, Lin JJ, Hsia SH. Factors associated with nontraumatic rhabdomyolysis and acute renal failure of children in Taiwan population. Pediatr Emerg Care 2009;25:657-60. https://doi.org/10.1097/PEC.0b013e3181bec7b4
  16. Kim JH, Goo MJ, Yeom JS, Park ES, Seo JH, Lim JY, et al. Clinical characteristics of acute renal failure of rhabdomyolysis in children. Korean J Pediatr 2007;50:277-83. https://doi.org/10.3345/kjp.2007.50.3.277
  17. Chen CY, Lin YR, Zhao LL, Yang WC, Chang YJ, Wu KH, et al. Clinical spectrum of rhabdomyolysis presented to pediatric emergency department. BMC Pediatr 2013;13:134. https://doi.org/10.1186/1471-2431-13-134
  18. Mannix R, Tan ML, Wright R, Baskin M. Acute pediatric rhabdomyolysis: causes and rates of renal failure. Pediatrics 2006;118:2119-25. https://doi.org/10.1542/peds.2006-1352
  19. Watemberg N, Leshner RL, Armstrong BA, Lerman-Sagie T. Acute pediatric rhabdomyolysis. J Child Neurol 2000;15:222-7. https://doi.org/10.1177/088307380001500404
  20. Watanabe T. Rhabdomyolysis and acute renal failure in children. Pediatr Nephrol 2001;16:1072-5. https://doi.org/10.1007/s004670100030
  21. Kasaoka S, Todani M, Kaneko T, Kawamura Y, Oda Y, Tsuruta R, et al. Peak value of blood myoglobin predicts acute renal failure induced by rhabdomyolysis. J Crit Care 2010;25:601-4. https://doi.org/10.1016/j.jcrc.2010.04.002
  22. Simpson JP, Taylor A, Sudhan N, Menon DK, Lavinio A. Rhabdomyolysis and acute kidney injury: creatine kinase as a prognostic marker and validation of the McMahon Score in a 10-year cohort: a retrospective observational evaluation. Eur J Anaesthesiol 2016;33:906-12. https://doi.org/10.1097/EJA.0000000000000490
  23. Rodriguez E, Soler MJ, Rap O, Barrios C, Orfila MA, Pascual J. Risk factors for acute kidney injury in severe rhabdomyolysis. PLoS One 2013;8:e82992. https://doi.org/10.1371/journal.pone.0082992
  24. Baeza-Trinidad R, Brea-Hernando A, Morera-Rodriguez S, Brito-Diaz Y, Sanchez-Hernandez S, El Bikri L, et al. Creatinine as predictor value of mortality and acute kidney injury in rhabdomyolysis. Intern Med J 2015;45:1173-8. https://doi.org/10.1111/imj.12815
  25. Zeng X, Zhang L, Wu T, Fu P. Continuous renal replacement therapy (CRRT) for rhabdomyolysis. Cochrane Database Syst Rev 2014;(6):CD008566.

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