Acute Kidney Injury due to Rhabdomyolysis Followed by Alcohol Intake and Physical Aggression: Case Report and Literature Review

Elizabeth De Francesco Daher,Geraldo Bezerra Da Silva Júnior,Meissa Kretzman,Neiberg De Alcantara Lima,Pedro Henrique De Oliveira Filgueira,Rafael Siqueira Athayde Lima,Ticiano Adler De Sousa Sindeaux

doi:10.3329/jom.v13i2.12759

Abstract

Rhabdomyolysis is defined as a skeletal muscle injury, with subsequent release of cellular constituents into the extracellular fluid and the circulation. Several conditions can lead to rhabdomyolysis, and new causes are constantly expanded with new case reports. The aim of this paper is to report on a case of acute kidney injury (AKI) induced by rhabdomyolysis due to alcohol abuse and physical agression. A 48-year-old man was admitted to the emergency room with dyspnea, lower limbs edema, weakness, oliguria and dark brown urine. Four days before admission he was physically attacked, after drinking almost 2.5 liters of beer. The diagnosis of AKI due to rhabdomyolysis was made through clinical and laboratory findings (creatine kinase 184,376 IU/l, serum urea 275 mg/dL, creatinine 14.6 mg/ dL, potassium 7.9 mEq/L). Urgency hemodyalisis was started due to anuria, refractory hiperkalemia and hypercatabolism. Recovery of renal function was recorded, after fourteen hemodialysis sessions. Patients with rhabdomyolysis are common in the emergency room. Initial therapy of fluid replacement is essential to prevent progression to renal failure. Once established, the dialysis is indicated early. The prognosis is good, when early supportive therapy is adequate. DOI: http://dx.doi.org/10.3329/jom.v13i2.12759 J Medicine 2012; 13 : 212-215

Highlights

Rhabdomyolysis is defined as a skeletal muscle injury, with subsequent release of cellular constituents into the extracellular fluid and the circulation
After patient‘s consent, we report the case of a male patient who, after alcoholic libation, was physically attacked in a robbery attempt and developed acute kidney injury (AKI) requiring dialysis
The endpoint of rhabdomyolysis is the destruction of the structure and/or abnormal metabolism of skeletal muscle cells, leading to cell death and lysis, with subsequent release of intracellular constituents into the circulation.[6]

Summary

Introduction

Rhabdomyolysis is defined as a skeletal muscle injury, with subsequent release of cellular constituents into the extracellular fluid and the circulation. The clinical findings were intense myalgia and decreased urine output in the day after the event and evolved to progressive legs swelling and dyspnea He was evaluated in the day before at another hospital where head trauma or other bone fractures have been discarded. Acute Kidney Injury due to Rhabdomyolysis Followed by Alcohol Intake and Physical Aggression excoriations, specially in the thighs and lower limbs edema until the knees (Figure 1). His blood pressure was 190x100mmHg and the cardiac and respiratory rates were. After 14 sessions of hemodialysis, the urine volume started to increase, and the levels of urea and creatinine decreased He was discharged from hospital after 30 days. Ur: serum urea, Cr: serum creatinine, K: serum potassium, Na: serum sodium, Ca: serum total calcium, Ht: hematocrit, Hb: Hemoglobin, WBC: white bood cell, Plq: platelet count, AST: aspartate amino transaminase, ALT: alanine amino transaminase, CK: creatine kinase, DHL: lactate dehydrogenase.Table-I

Discussion

Findings

Zager RA