#6665 NON TRAUMATIC RHABDOMYOLYSIS AND ACUTE RENAL FAILURE: WHICH INDICATIONS OF RENAL REPLACEMENT THERAPY?

Abstract

Abstract Background and Aims The aim of our study is to identify the causes of non-traumatic rhabdomyolysis in our context, to study the clinical and biological presentation of patients and the indications of renal replacement therapy in the management of this entity. Method Our study is a monocentric retrospective study conducted at the universitary hospital Mohamed VI of Marrakech including 14 patients who presented rhabdomyolysis complicated by acute kidney inury (AKI) with no traumatic context. Those patients were followed up at intensive care unit and nephrology department over a period of 10 months from March to December 2022. Results The age of our patients varied between 24 and 64 years for an average of 42 years. The male sex was predominant (78.57%) 11 men versus 3 women with no history of previous kidney disease. The average hospital stay was 20 days [12-42 days]. The most common clinical signs were oligo-anuria (85.7%), abdominal pain (57.1%), nausea and vomiting (42.8%), flank pain (42.8%) and muscle pain (14.2%), hypertension in 5 patients (35.7%), while 4 were hypotensive. The average creatinine on admission was 22mg/l [14-42.3], the average CPK level was 6240UI/L [2225-12570], the myoglobin was assayed in a single patient which returned positive at 6230 mg/l. The mean serum potassium was 5.6mmol/l [4.2-8.1], serum phosphorus was 45mg/l [32-72mg/l], serum calcium 81.2mg/l [68- 91] and bicarbonate 12 mmol/l [4-22]. The etiologies of rhabdmyolysis in our series were as follows: In 3 cases rhabdomyolysis was related to prolonged immobilization, in 3 cases it occurred in a postoperative context (post-vascular surgery of femoro-popliteal bypass and ilio-popliteal bypass in 2 cases and orthopedic surgery for a bone tumor of the tibia in one case), in 3 patients rhabdomyolysis was related to severe sepsis. In 2 cases, it was a status epilepticus, in 2 cases a neuroleptic malignant syndrome and in one case it occurred post-IdM. Management was based on hemodynamic and respiratory support through the restoration of blood volume by intravenous (100% of patients) and oral (83.3%) rehydration, the use of vasoactive drugs (35.7%), the correction of metabolic disorders essentially hyperkalaemia and acidosis and the etiological treatment of the causal condition. RRT (Renal replacement therapy) was indicated in a total of 5 patients: In 3 patients with anuria > 24 hours and in 2 with threatening hyperkalaemia. The modalities were as follows: The technique used was daily IHD (intermittent hemodialysis) lasting from 1h30 to 4h. The average number of hemodialysis sessions was 3.6 (minimum of 3 sessions maximum of 5). The evolution of the patients was as follows: Among the 9 patients not on dialysis, 6 recovered normal renal function, 2 maintained an IR at discharge (creatinine at 13 and 19 mg/l respectively) and one patient died of septic shock. Among the 5 patients on dialysis, two recovered good renal function with recovery of diuresis, 2 remained on kidney failure, and one patient died due to multiple organ failure. Conclusion The management of non traumatic rhabdomyolysis is based above all on rehydration in order to establish blood volume and eliminate the myoglobin pigment. The use of RRT is necesseray in some cases such as sever acute renal failure, threatening hyperkalaemia, acidosis or persistent anuria. Several studies suggest the benefit of its early initiation, which still remains to be demonstrated.