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Review
. 2014 Jan-Feb;56(1):85-8.
doi: 10.1590/S0036-46652014000100014.

Biopsy proven acute tubular necrosis due to rhabdomyolysis in a dengue fever patient: a case report and review of literature

Liliany P Repizo  1 , Denise M Malheiros  1 , Luis Yu  1 , Rui T Barros  1 , Emmanuel A Burdmann  1
Affiliations
Review

Biopsy proven acute tubular necrosis due to rhabdomyolysis in a dengue fever patient: a case report and review of literature

Liliany P Repizo et al. Rev Inst Med Trop Sao Paulo. 2014 Jan-Feb.

Abstract
in English, Portuguese

Renal histology results are very scarce in dengue-associated rhabdomyolysis patients developing acute kidney injury (AKI). We report a case of dengue fever-induced AKI associated to rhabdomyolysis with a renal biopsy showing acute tubular necrosis (ATN) and renal deposition of myoglobin. A 28-year-old patient who presented dengue fever (DF) complicated by severe AKI and rhabdomyolysis is described. The patient required hemodialysis for three weeks. A renal biopsy revealed ATN with positive staining for myoglobin in the renal tubuli. The patient was discharged with recovered renal function. In conclusion, this case report described a biopsy proven ATN associated to DF-induced rhabdomyolysis, in which renal deposition of myoglobin was demonstrated. We suggest that serum creatine phosphokinase should be monitored in DF patients to allow for an early diagnosis of rhabdomyolysis and the institution of renal protective measures.

Resultados de histologia renal são muito escassos em pacientes com rabdomiólise e injúria renal aguda (IRA) associada a dengue. Descrevemos caso de dengue complicado por rabdomiólise e IRA no qual a biópsia renal mostrou necrose tubular aguda (NTA) e deposição renal de mioglobina. Paciente de 28 anos que apresentou dengue complicado por IRA grave e rabdomiólise é descrito. Ele necessitou de diálise por três semanas. A biópsia renal mostrou NTA, com imunohistoquímica fortemente positiva para mioglobina nos túbulos renais. O paciente recebeu alta com recuperação da função renal. Em conclusão, descrevemos caso de dengue complicado por IRA e rabdomiólise, em que a biópsia renal mostrou NTA e deposição de mioglobina. Sugerimos que creatinofosfoquinase deve ser monitorizada em pacientes com dengue para permitir o diagnóstico precoce de rabdomiólise e a instituição de medidas protetoras para o rim.

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Figures

Fig. 1
Fig. 1. A. Light microscopy of renal tissue stained with Masson's trichrome (20X). Note the presence of diffuse acute tubular necrosis and preserved glomeruli. In the interstitial area, thin fibrosis lines and edema are evident. B. Immunostaining of renal tissue. Note the positive immunostaining for myoglobin in the cytoplasm of the tubular cells.
See this image and copyright information in PMC

Comment in

  • Acute tubular necrosis and dengue.
    Wiwanitkit V. Wiwanitkit V. Rev Inst Med Trop Sao Paulo. 2014 Jul-Aug;56(4):312. doi: 10.1590/s0036-46652014000400008. Rev Inst Med Trop Sao Paulo. 2014. PMID: 25076432 Free PMC article. No abstract available.

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