[Diagnosis and treatment of 23 cases with rhabdomyolysis related acute renal failure]

Abstract

Objective: To investigate the occurrence rate, therapeutic effect and prognosis of rhabdomyolysis related acute renal failure(RM-ARF).

Methods: Twenty-three patients were investigated, 17 male and 6 female, mean age was (38.00+/-17.13) years. The blood samples of 23 patients were analyzed, using a series of serum creatine phosphokinases (CPK) and L-lactate dehydrogenase (LDH) and biochemical detection items, including serum myoglobin, serum electrolytes (Na(+), K(+), Cl(-), Ca(2+), P(3+), HCO(-3)), liver and renal function, serum albumin, uric acid, hemoglobulin, arterial blood-gas analysis, the results of disseminated intravascular coagulation (DIC) etc. Three patients were undergone renal biopsy and immunohistological En Vision test of renal tubular myoglobin deposits.

Results: The occurrence rate of RM-ARF was 5.96% of all ARF patients. Serum CPK level and some electrolytes increased significantly. Renal pathology indicated acute tubular necrosis in 3 patients with all positive immunohistological results of myoglobin. Eight patients had muscular injury without muscular biopsy identified, that extrarenal hemopurification as hemodialysis(HD), continuous ambulatory peritoneal dialysis (CAPD), continuous venous venous hemofiltration (CVVH) were examined in 18 patients. After treatment, the mortality rate of RM-ARF was about 34.78%(8/23), the rest patients survived and 12 patients recovered with normal renal function.

Conclusion: The most pathogenesis of RM are not traumatic. The test of CPK level and some biochemical detection items is an effective way to raise the diagnosis rate. Renal biopsy can make the diagnosis of RM-ARF in early stage, and improve the prognosis, lower the mortality rate.