Rhabdomyolysis is a syndrome caused by skeletal muscle cells destruction which can occur for many reasons, including prolonged immobilization. The main complication of the syndrome is the development of acute renal failure. Rhabdomyolysis and myoglobinuria are responsible for approximately 5% of all causes of acute renal failure in the USA. The cause of rhabdomyolysis is often multifactorial, and approximately 8–20% of such patients develop myoglobinuric acute renal failure. 1. Introduction Rhabdomyolysis is characterized by muscle cell destruction and the subsequent leakage of muscle cell contents, including electrolytes, sarcoplasmic myoglobin, and other proteins into the circulation . Acute kidney injury is a potential complication of severe rhabdomyolysis , and the prognosis is much worse if renal failure develops when the main cause is any trauma [3, 4]. In spite of the fact that conventional hemodialysis filters do not remove myoglobin, hemodiafiltration with super-high-flux dialyzers may be effective . Our aim is to report a case of acute kidney injury due to rhabdomyolysis in which we used continuous venovenous hemodiafiltration (CVVH) in the intensive care unit of a tertiary university hospital. 2. Case Presentation An 82-year-old woman, independent as regards activities of daily life, was admitted into the emergency department due to accidental fall at home with consecutive immobilization for a period of approximately 12 hours. Her medical history includes hypertension, dyslipidemia, non-insulin-dependent diabetes, and mild chronic renal insufficiency (baseline creatinine 1.4？mg/dL). The accidental fall caused right femur periprosthetic supracondylar fracture, which is pending surgery. Blood sample analysis at admission was the following: creatinine 8.74？mg/dL, urea 210？mg/dL with anuria compatible with kidney injury according to RIFLE criteria , and the patient was transferred to the intensive care unit (ICU). At the time of admission to the ICU, blood sample analysis showed the following: creatinine 8.76？mg/dL, urea 202？mg/dL, and potassium 6.4？mEq/L, and arterial blood gas analysis showed metabolic acidosis: pH 7.02, ？24.6 base excess, serum bicarbonate 4.3？mEq/L, partial pressure of oxigen 79？mmHg and partial pressure of carbon dioxide 16.9 mmHg of creatine phosphokinase (CK) 9475？U/L, with oliguria. Continuous venovenous hemofiltration (CVVHF) with (Edwards Aquarius, Irvine-based Edwards Lifesciences Corp. Lone Peak Parkway, Draper, UT？84020, USA Irvine, CA, USA) 1,2 polysulphone m2 membrane was started with the sequent
R. Bellomo, C. Ronco, J. A. Kellum, R. L. Mehta, and P. Palevsky, “Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group,” Critical care, vol. 8, no. 4, pp. R204–R212, 2004.
R. A. Zager and C. A. Foerder, “Effects of inorganic iron and myoglobin on in vitro proximal tubular lipid peroxidation and cytotoxicity,” Journal of Clinical Investigation, vol. 89, no. 3, pp. 989–995, 1992.
T. S. Mikkelsen and P. Toft, “Prognostic value, kinetics and effect of CVVHDF on serum of the myoglobin and creatine kinase in critically ill patients with rhabdomyolysis,” Acta Anaesthesiologica Scandinavica, vol. 49, no. 6, pp. 859–864, 2005.
K. P. Moore, S. G. Holt, R. P. Patel et al., “A causative role for redox cycling of myoglobin and its inhibition by alkalinization in the pathogenesis and treatment of rhabdomyolysis-induced renal failure,” Journal of Biological Chemistry, vol. 273, no. 48, pp. 31731–31737, 1999.
O. S. Better and J. H. Stein, “Current concepts: early management of shock and prophylaxis of acute renal failure in traumatic rhabdomyolysis,” New England Journal of Medicine, vol. 322, no. 12, pp. 825–829, 1990.