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Ohara N, Tani T, Terajima K, Ozawa T, Yoneoka Y, Shimada H, Nakamura Y, Hasegawa G, Nishiyama T. Primary Aldosteronism and Hypokalemia-induced Rhabdomyolysis in a Patient with Aldosterone-producing Adenoma: A Case Report and Literature Review. Intern Med 2025; 64:871-879. [PMID: 39135257 PMCID: PMC11986306 DOI: 10.2169/internalmedicine.3629-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/27/2024] [Indexed: 03/18/2025] Open
Abstract
Many cases of primary aldosteronism (PA) in patients who developed hypokalemia-induced rhabdomyolysis and underwent adrenalectomy for aldosterone-producing adenoma (APA) have been reported; however, the immunohistopathological and molecular features remain unknown. We herein report the case of a 28-year-old woman with PA who presented with hypokalemia-induced rhabdomyolysis and underwent adrenalectomy for unilateral APA. An immunohistochemical analysis revealed that most adenoma cells were positive for steroidogenic enzymes, including CYP11B2. A genetic analysis revealed a somatic mutation in the KCNJ5. These findings suggest a strong aldosterone production capacity in our patient's adenoma, which was presumably related to her severe hyperaldosteronism and the resultant hypokalemia-induced rhabdomyolysis.
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Affiliation(s)
- Nobumasa Ohara
- Department of Endocrinology and Metabolism, Uonuma Kikan Hospital, Japan
| | - Takashi Tani
- Department of Neurology, Uonuma Kikan Hospital, Japan
| | | | | | | | - Hiroki Shimada
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Japan
| | - Yasuhiro Nakamura
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Japan
| | - Go Hasegawa
- Department of Pathology, Uonuma Kikan Hospital, Japan
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Karimi M, Faal Hamedanchi N, Ansari K, Nahavandi R, Mazdak M, Javaherchian F, Koochaki P, Asadi Anar M, Shirforoush Sattari M, Mohamaditabar M. Rhabdomyolysis secondary to COVID-19 infection and vaccination: a review of literature. Front Med (Lausanne) 2024; 11:1460676. [PMID: 39635585 PMCID: PMC11614617 DOI: 10.3389/fmed.2024.1460676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 11/06/2024] [Indexed: 12/07/2024] Open
Abstract
Rhabdomyolysis (RML), characterized by the breakdown of skeletal muscle fibers and the release of muscle contents into the bloodstream, has emerged as a notable complication associated with Coronavirus disease 2019 (COVID-19) infection and vaccination. Studies have reported an increased incidence of RML in individuals with severe COVID-19 infection. However, the exact mechanisms remain unclear and are believed to involve the host's immune response to the virus. Furthermore, RML has been documented as a rare adverse event following COVID-19 vaccination, particularly with mRNA vaccines. Proposed mechanisms include immune responses triggered by the vaccine and T-cell activation against viral spike proteins. This study aims to review the current literature on the incidence, pathophysiology, clinical presentation, and outcomes of RML secondary to COVID-19 infection and vaccination. We identify common risk factors and mechanisms underlying this condition by analyzing case reports, clinical studies, and pharmacovigilance data. Our findings suggest that while RML is a relatively rare adverse event, it warrants attention due to its potential severity and the widespread prevalence of COVID-19 and its vaccines. This review underscores the need for heightened clinical awareness and further research to optimize management strategies and improve patient outcomes in this context.
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Affiliation(s)
- Mehdi Karimi
- Faculty of Medicine, Bogomolets National Medical University, Kyiv, Ukraine
| | - Neda Faal Hamedanchi
- Faculty of Medicine, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran
| | - Kazem Ansari
- Nano-Biotech Foresight Company Biotechnology Campus, Yazd Stem Cells and Regenerative Medicine Institute, Yazd, Iran
| | - Reza Nahavandi
- Department of Biochemical and Pharmaceutical Engineering, School of Chemical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Mahsa Mazdak
- School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Fateme Javaherchian
- School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Pooneh Koochaki
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Mahsa Asadi Anar
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Altaf F, Bhatt V, Venkatram S, Diaz-Fuentes G. Crushing Muscles: A Case Study on Rhabdomyolysis, Renal Failure, and Compartment Syndrome Triggered by Pre-Workout Supplement Abuse. Cureus 2024; 16:e58775. [PMID: 38784349 PMCID: PMC11111323 DOI: 10.7759/cureus.58775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/25/2024] Open
Abstract
The use of steroids and protein-based dietary supplements for muscle enhancement is prevalent in contemporary society. While these products promise increased muscle mass and strength, they carry significant risks, including severe medical complications. The consumption of these supplements has been linked to adverse symptoms, including dehydration, gastrointestinal distress, dizziness, and alterations in heart rate and blood pressure, primarily due to ingredients like creatine, arginine, and caffeine. Following the proper dosage, ensuring adequate hydration, and consulting a healthcare provider to verify if the supplement's components could affect any pre-existing conditions is recommended. Indiscriminate use of these products, including taurine, can lead to serious side effects. We present a 36-year-old patient with severe rhabdomyolysis, life-threatening acid-base imbalance, renal and liver injury, and peripheral neuropathy associated with the use of performance-enhanced unregulated supplements and exercise. This case highlights the importance of recognizing and managing complications related to exercise-aid supplements, emphasizing early identification and management. Increasing social awareness and research on those products is highly needed to avoid supplement-associated complications and potential long-term disabilities.
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Affiliation(s)
- Faryal Altaf
- Internal Medicine, BronxCare Health System, Bronx, USA
| | | | | | - Gilda Diaz-Fuentes
- Pulmonary and Critical Care Medicine, BronxCare Health System, Bronx, USA
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Grover KM, Sripathi N. Prevention of Adverse Outcomes and Treatment Side Effects in Patients with Neuromuscular Disorders. Semin Neurol 2022; 42:594-610. [PMID: 36400111 DOI: 10.1055/s-0042-1758779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In this article, we review prevention of serious adverse clinical outcomes and treatment side effects in patients with neuromuscular disorders including myopathies and myasthenia gravis. While neither of these entities is preventable, their course can often be modified, and severe sequelae may be prevented, with the identification of risk factors and proactive attention toward treatment planning.
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Affiliation(s)
- Kavita M Grover
- Department of Neurology, Henry Ford Medical Group, Wayne State University, Detroit, Michigan
| | - Naganand Sripathi
- Department of Neurology, Henry Ford Medical Group, Wayne State University, Detroit, Michigan
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5
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Recurrent acute kidney injury and rhabdomyolysis: Questions. Pediatr Nephrol 2021; 36:4045-4046. [PMID: 34251490 DOI: 10.1007/s00467-021-05170-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 05/26/2021] [Accepted: 06/03/2021] [Indexed: 10/20/2022]
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Ren L, Wei C, Wei F, Ma R, Liu Y, Zhang Y, Wang W, Du J, Bai L, Xue Y, Cui S. A case report of rhabdomyolysis and osteofascial compartment syndrome in a patient with hypothyroidism and diabetes. BMC Endocr Disord 2021; 21:212. [PMID: 34689788 PMCID: PMC8543899 DOI: 10.1186/s12902-021-00868-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/08/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hypothyroidism is frequent and has various forms of muscle involvement. We report the diagnosis and treatment of a case of rhabdomyolysis, bilateral osteofascial compartment syndrome (OCS) of the lower extremities, and peroneal nerve injury causing bilateral foot drop in a diabetic patient with hypothyroidism. CASE PRESENTATION A 66-year-old man with diabetes for 22 years was admitted because of drowsiness, tiredness, facial swelling, and limb twitching for 2 months, and red and swollen lower limb skin for 3 days. Serum creatinine kinase (CK), CK-MB, myoglobin (Mb), blood glucose, and HbA1c were elevated. TSH, thyroid peroxidase antibodies, and antithyroglobulin antibodies were elevated. FT3 and FT4 were low. Urine was dark brown. He was diagnosed with hypothyroidism, rhabdomyolysis, and OCS. CK, CK-MB, and Mb returned to normal after treatment with thyroid hormone, insulin, albumin infusion, ceftriaxone, ulinastatin, and hemofiltration, and the redness and swelling of the lower limbs were relieved, but the patient developed dropping feet. The patient recovered well but had to undergo rehabilitation. CONCLUSION Hypothyroidism may induce rhabdomyolysis, OCS, and other complications. This case reminds us of the importance of screening for hypothyroidism and strengthens the clinicians' understanding of the disease.
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Affiliation(s)
- Lijue Ren
- Department of Endocrinology, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, 41 Linyin Road, Kun District, Baotou City, 014010, Inner Mongolia, China
| | - Cuiying Wei
- Department of Endocrinology, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, 41 Linyin Road, Kun District, Baotou City, 014010, Inner Mongolia, China.
| | - Feng Wei
- Department of Endocrinology, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, 41 Linyin Road, Kun District, Baotou City, 014010, Inner Mongolia, China
| | - Ruiting Ma
- Department of Endocrinology, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, 41 Linyin Road, Kun District, Baotou City, 014010, Inner Mongolia, China
| | - Yan Liu
- Department of Endocrinology, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, 41 Linyin Road, Kun District, Baotou City, 014010, Inner Mongolia, China
| | - Yonghong Zhang
- Department of Endocrinology, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, 41 Linyin Road, Kun District, Baotou City, 014010, Inner Mongolia, China
| | - Wei Wang
- Department of Endocrinology, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, 41 Linyin Road, Kun District, Baotou City, 014010, Inner Mongolia, China
| | - Jing Du
- Department of Endocrinology, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, 41 Linyin Road, Kun District, Baotou City, 014010, Inner Mongolia, China
| | - Lin Bai
- Department of Endocrinology, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, 41 Linyin Road, Kun District, Baotou City, 014010, Inner Mongolia, China
| | - Yexia Xue
- Department of Endocrinology, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, 41 Linyin Road, Kun District, Baotou City, 014010, Inner Mongolia, China
| | - Shaohua Cui
- Intensive Care Unit, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, 014010, Inner Mongolia, China
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Yuan X, Chen S, Huang Y. Successful treatment of tuberculosis combined with drug-induced myopathy using corticosteroid therapy: a case report. J Int Med Res 2021; 49:3000605211043239. [PMID: 34525861 PMCID: PMC8450684 DOI: 10.1177/03000605211043239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 39-year-old woman was admitted to our hospital on 19 January 2019 because of a 10-day history of intolerance to oils in her food, fatigue, and yellowing of the skin and sclera. In December 2018, the patient had been diagnosed with tuberculous pleurisy at a local hospital and received quadruple anti-tuberculosis treatment. Ten days before presentation to our hospital, she had developed anorexia, fatigue, nausea, loss of appetite, cough, and shortness of breath. She visited a local hospital, where she was considered to have drug-induced hepatitis. She discontinued the anti-tuberculosis drugs and liver protection treatment. After 3 days, her symptoms had not substantially improved. She visited the infection department of our hospital for further diagnosis and treatment. After 6 days of treatment, the patient's symptoms were not significantly improved, her liver and muscle enzyme concentrations were further increased, and her limbs had become weaker and more difficult to move. We considered diagnoses of drug-induced hepatitis and drug-induced myopathy. The patient was treated with intravenous methylprednisolone at 40 mg once a day for 16 days and other symptomatic treatments. Her symptoms significantly improved and she was discharged.
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Affiliation(s)
- Xinke Yuan
- Department of Nephrology, the First Hospital of Changsha, Kaifu District, Changsha, Hunan, China
| | - Sijia Chen
- Department of Nephrology, the First Hospital of Changsha, Kaifu District, Changsha, Hunan, China
| | - Yinghong Huang
- Department of Nephrology, the First Hospital of Changsha, Kaifu District, Changsha, Hunan, China
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Alanazi NS, Alenazi TS, Alenzi KA. Hepatotoxicity Induced by Fluvastatin: A Reversible Acute Cholestatic Liver Injury. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931418. [PMID: 34383728 PMCID: PMC8369431 DOI: 10.12659/ajcr.931418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Patient: Male, 69-year-old
Final Diagnosis: Acute renal failure • cholestatic jaundice and myositis induced by fluvastatin • stage 3 chronic kidney disease
Symptoms: Abdominal pain, loss of appetite • fatigue • jaundiced and tender in the upper right quadrant of his abdomen • vomiting, dark urine, and itching • weakness • yellowish discoloration of the skin
Medication: —
Clinical Procedure: Abdominal ultrasound
Specialty: General and Internal Medicine
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Affiliation(s)
- Najah S Alanazi
- Regional Drug Information & Pharmacovigilance Centre, Ministry of Health, Tabuk, Saudi Arabia
| | - Tahani S Alenazi
- Regional Drug Information & Pharmacovigilance Centre, Ministry of Health, Tabuk, Saudi Arabia
| | - Khalidah A Alenzi
- Regional Drug Information & Pharmacovigilance Centre, Ministry of Health, Tabuk, Saudi Arabia
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9
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Gardner HM, Askenazi DJ, Hoefert JA, Helton A, Wu CL. Acute Kidney Injury Among Children Admitted With Viral Rhabdomyolysis. Hosp Pediatr 2021; 11:878-885. [PMID: 34301717 PMCID: PMC10118290 DOI: 10.1542/hpeds.2020-005108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Infectious etiologies cause a large portion of pediatric rhabdomyolysis. Among pediatric patients with rhabdomyolysis, it is unknown who will develop acute kidney injury (AKI). We sought to test the hypothesis that a viral etiology would be associated with less AKI in children admitted with rhabdomyolysis than a nonviral etiology. METHODS In this single-center retrospective cohort study, patients <21 years of age admitted with acute rhabdomyolysis from May 1, 2010, through December 31, 2018, were studied. The primary outcome was development of AKI, defined by using the Kidney Disease: Improving Global Outcomes guidelines. The primary predictor was identification of viral infection by laboratory testing or clinical diagnosis. Covariates included age, sex, race, insurance provider, presence of proteinuria and myoglobinuria, and initial creatinine kinase and serum urea nitrogen. Routine statistics and multivariable logistic modeling were performed via SAS 9.4 (SAS Institute, Inc, Cary, NC). RESULTS In total, 319 pediatric patients with rhabdomyolysis were studied. The median age was 13 years. Patients were predominately male (69.9%), non-Hispanic Black (55.2%), and publicly insured (45.1%). We found no difference in the rates of AKI in those with a viral diagnosis versus those without a viral diagnosis (30 of 77 [39.0%] vs 111 of 234 [47.4%]; P = .19). Multivariable analysis revealed that viral diagnosis was not associated with the development of AKI. Patients ≥13 years of age, male patients, and those with proteinuria and elevated serum urea nitrogen on admission had increased odds of developing AKI. CONCLUSIONS In our study, viral rhabdomyolysis did not have lower rates of AKI compared with nonviral etiologies of AKI; therefore, providers should consider continued caution in these patients.
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Affiliation(s)
- Hannah M Gardner
- Division of Pediatric Hospital Medicine, Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado
| | | | - Jennifer A Hoefert
- Division of General Academic Pediatrics, Section of Pediatric Hospital Medicine, Saint Louis University and Cardinal Glennon Children's Hospital, St Louis, Missouri
| | - Alexis Helton
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Chang L Wu
- Pediatric Hospital Medicine, Department of Pediatrics
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Rhabdomyolysis plus Hypocalcemia and Diabetic Ketoacidosis as Concurrent Rare COVID-19 Manifestations. Case Rep Med 2021; 2021:6625086. [PMID: 33747093 PMCID: PMC7945673 DOI: 10.1155/2021/6625086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/23/2021] [Accepted: 02/27/2021] [Indexed: 12/14/2022] Open
Abstract
Background Common manifestations of coronavirus disease 2019 (COVID-19) from its initial official introduction are mostly related to the respiratory system. However, other rarer presentations are reported nowadays. Case Presentations. We reported three cases of COVID-19-infected patients with rhabdomyolysis as well as two other rarer simultaneous signs, including hypocalcemia (Case 1) and diabetic ketoacidosis (DKA) (Case 2). Conclusion Despite the fact that rhabdomyolysis is an infrequent manifestation of COVID-19, high clinical suspicion is required for proper diagnosis and management of this disease as well as other concurrent rarer presentations, including hypocalcemia and DKA for the prevention of further complications.
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Jahnke VS, Poloni JAT, Neves CAM, Peter C, Thompson CE, Rotta LN. Acute kidney injury associated with rhabdomyolysis in a patient with COVID-19. J Bras Nefrol 2021; 44:443-446. [PMID: 33704346 PMCID: PMC9518616 DOI: 10.1590/2175-8239-jbn-2020-0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/07/2020] [Indexed: 12/15/2022] Open
Abstract
Rhabdomyolysis is defined as the breakdown of skeletal muscle leading to the release of muscle contents into the extracellular fluid. Patients with rhabdomyolysis can be asymptomatic or have myalgia symptoms, weakness, myoglobinuria with dark urine, significant electrolyte imbalance, and acute kidney injury. Here we describe a case on acute kidney injury associated to rhabdomyolysis in a patient with COVID-19.
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Affiliation(s)
| | | | - Carla Andretta Moreira Neves
- Hospital São Camilo, Esteio, RS, Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-Graduação em Ciências da Saúde, Porto Alegre, RS, Brasil
| | | | - Claudia Elizabeth Thompson
- Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-Graduação em Ciências da Saúde, Porto Alegre, RS, Brasil
| | - Liane Nanci Rotta
- Universidade Federal de Ciências da Saúde de Porto Alegre, Programa de Pós-Graduação em Ciências da Saúde, Porto Alegre, RS, Brasil
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12
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Alrubaye R, Choudhury H. Severe Rhabdomyolysis in a 35-Year-old Woman with COVID-19 due to SARS-CoV-2 Infection: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e926733. [PMID: 32801291 PMCID: PMC7440748 DOI: 10.12659/ajcr.926733] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Rhabdomyolysis is a skeletal muscle injury that has different etiologies and can be a manifestation of coronavirus disease 2019 (COVID-19). Because it is a life-threatening condition, rapid diagnosis is necessary to prevent acute complications. Diagnostic criteria for rhabdomyolysis are elevated serum creatine kinase, liver enzyme levels, and myalgia. Rhabdomyolysis can easily be missed in patients with COVID-19. Herein, we report the case of a female with rhabdomyolysis as a manifestation of acute COVID-19. CASE REPORT A 35-year-old female was found to have rhabdomyolysis associated with COVID-19. Her creatine kinase and liver enzyme levels were significantly elevated. Ringer's lactate infusion was administered at a controlled rate to treat the rhabdomyolysis along with boluses of normal saline, with close monitoring of her oxygen saturation and kidney function. The patient's creatine kinase and liver enzyme levels peaked on Day 2 and then decreased. Her medical condition improved, and she was discharged on Day 4. CONCLUSIONS Our case highlights the need to monitor the creatine kinase level of hospitalized patients with COVID-19. Fluid management can be challenging in patients with rhabdomyolysis due to COVID-19 because of the risk of fluid overload and acute respiratory distress syndrome. Clinicians should be aware that a significant elevation in liver enzyme levels and myalgia can be the presenting features of rhabdomyolysis in patients with COVID-19.
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Affiliation(s)
- Riyadh Alrubaye
- Department of Hospital Medicine, Northeast Georgia Health System, Gainesville, GA, USA
| | - Hasan Choudhury
- Department of Graduate Medical Education, Internal Medicine Residency Program, Northeast Georgia Health System, Gainesville, GA, USA
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Khurshid Q, Khalid L, Usman N, Neupane N, Mahmoud A. Rhabdomyolysis Induced Acute Kidney Injury in Hyperglycemic Hyperosmolar State Patient With New-Onset Diabetes: A Case Report. Cureus 2020; 12:e9188. [PMID: 32818120 PMCID: PMC7426665 DOI: 10.7759/cureus.9188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The hyperglycemic hyperosmolar state (HHS) is a serious acute complication of type 2 diabetes mellitus that requires prompt recognition, diagnosis, and treatment. Reversible acute kidney injury is common in hyperglycemic states. However, hyperglycemic emergencies can contribute to the development of rhabdomyolysis, which can further aggravate acute kidney injury and can cause high morbidity and mortality. HHS can be the first clinical presentation of diabetes mellitus in some patients. Here, we present a case of HHS-related rhabdomyolysis and acute kidney injury, which was the first presentation of type 2 diabetes mellitus in this patient. Our case highlights the importance of a rare association between rhabdomyolysis and HHS in diabetic patients.
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Rojas-Valverde D, Sánchez-Ureña B, Crowe J, Timón R, Olcina GJ. Exertional rhabdomyolysis and acute kidney injury in endurance sports: A systematic review. Eur J Sport Sci 2020; 21:261-274. [PMID: 32202487 DOI: 10.1080/17461391.2020.1746837] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The increase of wide-spread participation in endurance events in sports such as open water swimming, cycling, running and triathlons, has given rise to a concern about potential implications for renal function and kidney health. This study aimed to delve into the findings on exertional rhabdomyolysis (ER) and acute kidney injury (AKI) in endurance sports, emphasizing the diagnostic criteria used, physical and environmental contextual conditions in which ER and AKI are reported. Following PRISMA guidelines for systematic reviews and meta-analysis, topic related studies were searched digital sources (from 2009 to 2020). Studies with biomarkers of ER and AKI reported in endurance or ultra-endurance events were included. A total of 43 publications (sample = 813) were extracted, and 345 (43.5%) individuals were diagnosed with ER (creatinine kinase > 5000 UI/L) and 130 (16.39%) with ER + AKI (creatinine ≥ 1.88 mg/dL). Out of the total cases of ER + AKI, 96.92% were in ultra-endurance runners. There were inconsistences between studies in diagnosis criteria for ER and AKI, which represented a difficulty in the interpretation of the data. Increased levels of muscle and kidney injury immediately after endurance events were reported, but after 5.86 days these levels usually returned to baseline. There is a lack of knowledge around the potential of repeated ER and AKI predisposing to long-term chronic kidney disease. More accurate markers for subclinical and functional AKI diagnosis are needed in the analysis of kidney health after endurance events. ER and AKI are serious clinical problems with significant morbidity. Further research may be in order to help define future prevention strategies.
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Affiliation(s)
- Daniel Rojas-Valverde
- Centro de Investigación y Diagnóstico en Salud y Deporte, Escuela Ciencias del Movimiento Humano y Calidad de Vida, Universidad Nacional, Heredia, Costa Rica.,Grupo Avances en Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, Cáceres, Spain
| | - Braulio Sánchez-Ureña
- Programa de Ciencias del Ejercicio y la Salud, Escuela Ciencias del Movimiento Humano y Calidad de Vida, Universidad Nacional, Heredia, Costa Rica
| | - Jennifer Crowe
- Instituto Regional de Estudios Toxicológicos, Universidad Nacional, Heredia, Costa Rica
| | - Rafael Timón
- Grupo Avances en Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, Cáceres, Spain
| | - Guillermo J Olcina
- Grupo Avances en Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, Cáceres, Spain
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Abstract
COVID-19 is the illness caused by infection with the novel coronavirus SARS-CoV-2. Although myalgia is common in adults, it has not been noted as a common symptom in children. There have been a few reported cases of COVID-19-associated rhabdomyolysis in adults. This case report describes a 16-year-old boy who presented with fever, myalgias, mild shortness of breath with exertion, and dark-colored urine. COVID-19 PCR was positive. His initial creatinine kinase (CK) level was 427,656 U/L. Serum creatinine was normal for age. He was treated with isotonic intravenous fluids containing sodium bicarbonate to maintain urine output of 100-200 mL/h and urine pH > 7.0. His serum creatinine remained normal throughout the hospital stay and he was discharged on hospital day 12 with a CK of 6526 U/L. To our knowledge, no pediatric cases of COVID-19-associated rhabdomyolysis have been previously reported. Adult cases of rhabdomyolysis have been reported and a few reports have noted patients with elevated CK levels without rhabdomyolysis. Given this pediatric case of COVID-19-associated rhabdomyolysis, pediatric clinicians should be aware of this complication and manage fluids appropriately in order to prevent acute kidney injury.
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Hussain K, Xavier A. Rosuvastatin-related rhabdomyolysis causing severe proximal paraparesis and acute kidney injury. BMJ Case Rep 2019; 12:12/10/e229244. [PMID: 31601550 DOI: 10.1136/bcr-2019-229244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
We describe the case of a 76-year-old man who presented with bilateral lower limb weakness associated with decreased urine output. His initial blood results showed acute kidney injury (AKI) stage 3 with substantially raised serum creatine kinase concentration of 37 950 IU/L (normal range <171 U/L). He had been on high-dose rosuvastatin for 4 years with a recent brand change occurring 1 week prior to onset of symptoms. There was no history of pre-existing neuromuscular disease. Statin-related rhabdomyolysis was suspected and rosuvastatin was withheld. His muscle strength gradually improved. He required haemodialysis for 10 weeks. He was discharged home after a complicated course of hospitalisation. His renal function improved and he became dialysis-independent; however, he was left with residual chronic kidney disease.
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Affiliation(s)
- Kosar Hussain
- General Medicine, Goulburn Valley Health, Shepparton, Victoria, Australia
| | - Anil Xavier
- Nephrology and General Medicine, Goulburn Valley Health, Shepparton, Victoria, Australia
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Long B, Koyfman A, Gottlieb M. An evidence-based narrative review of the emergency department evaluation and management of rhabdomyolysis. Am J Emerg Med 2019; 37:518-523. [DOI: 10.1016/j.ajem.2018.12.061] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/20/2018] [Accepted: 12/31/2018] [Indexed: 12/13/2022] Open
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Park Y, Song JY, Kim SY, Kim SH. Clinical Characteristics of Rhabdomyolysis in Children : Single Center Experience. ACTA ACUST UNITED AC 2018. [DOI: 10.3339/jkspn.2018.22.2.52] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Leite MR, Zanetta DMT, Trevisan IB, Burdmann EDA, Santos UDP. Sugarcane cutting work, risks, and health effects: a literature review. Rev Saude Publica 2018; 52:80. [PMID: 30156601 PMCID: PMC6110589 DOI: 10.11606/s1518-8787.2018052000138] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 11/04/2017] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Describe the main work risks for sugarcane cutters and their effects on workers' health. METHODS Critical review of articles, with bibliographic research carried out in the PubMed, SciELO Medline, and Lilacs databases. The following keywords were used: sugarcane workers, sugarcane cutters, sugarcane harvesting, cortadores de cana-de-açú car , and colheita de cana -de-açúcar . The inclusion criteria were articles published between January 1997 and June 2017, which evaluated working conditions and health effects on sugarcane cutters. Those that did not deal with the work impact of cutting burned and unburnt sugarcane in the cutter's health were excluded. The final group of manuscripts was selected by the lead author of this study and reviewed by a co-author. Disagreements were resolved by consensus using the predefined inclusion and exclusion criteria and, where necessary, the final decision was made by consulting a third co-author. RESULTS From the 89 articles found, 52 met the selection criteria and were evaluated. Studies have shown that cutters work under conditions of physical and mental overload, thermal overload, exposure to pollutants, and are subject to accidents. The main effects observed were respiratory, cardiovascular, renal, musculoskeletal, heat stress, dehydration, genotoxic, and those due to accidents. CONCLUSIONS Work on the manual cutting of sugarcane, especially of burned sugarcane, exposes workers to various risks, with different health impacts. Risk reduction for exposure to pollution and thermal and physical overload is required as a measure to preserve the health of the worker.
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Affiliation(s)
- Marceli Rocha Leite
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Iara Buriola Trevisan
- Universidade Estadual Paulista "Júlio de Mesquita Filho". Departamento de Fisioterapia. Campus de Presidente Prudente. São Paulo, SP, Brasil
| | - Emmanuel de Almeida Burdmann
- Universidade de São Paulo. Faculdade de Medicina. Hospital das Clinicas. Divisão de Nefrologia. São Paulo, SP, Brasil
| | - Ubiratan de Paula Santos
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Leite MR, Zanetta DMT, Trevisan IB, Burdmann EDA, Santos UDP. Sugarcane cutting work, risks, and health effects: a literature review. Rev Saude Publica 2018. [PMID: 30156601 DOI: 10.11606/s15188787.2018052000138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
OBJECTIVE Describe the main work risks for sugarcane cutters and their effects on workers' health. METHODS Critical review of articles, with bibliographic research carried out in the PubMed, SciELO Medline, and Lilacs databases. The following keywords were used: sugarcane workers, sugarcane cutters, sugarcane harvesting, cortadores de cana-de-açú car , and colheita de cana -de-açúcar . The inclusion criteria were articles published between January 1997 and June 2017, which evaluated working conditions and health effects on sugarcane cutters. Those that did not deal with the work impact of cutting burned and unburnt sugarcane in the cutter's health were excluded. The final group of manuscripts was selected by the lead author of this study and reviewed by a co-author. Disagreements were resolved by consensus using the predefined inclusion and exclusion criteria and, where necessary, the final decision was made by consulting a third co-author. RESULTS From the 89 articles found, 52 met the selection criteria and were evaluated. Studies have shown that cutters work under conditions of physical and mental overload, thermal overload, exposure to pollutants, and are subject to accidents. The main effects observed were respiratory, cardiovascular, renal, musculoskeletal, heat stress, dehydration, genotoxic, and those due to accidents. CONCLUSIONS Work on the manual cutting of sugarcane, especially of burned sugarcane, exposes workers to various risks, with different health impacts. Risk reduction for exposure to pollution and thermal and physical overload is required as a measure to preserve the health of the worker.
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Affiliation(s)
- Marceli Rocha Leite
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Iara Buriola Trevisan
- Universidade Estadual Paulista "Júlio de Mesquita Filho". Departamento de Fisioterapia. Campus de Presidente Prudente. São Paulo, SP, Brasil
| | - Emmanuel de Almeida Burdmann
- Universidade de São Paulo. Faculdade de Medicina. Hospital das Clinicas. Divisão de Nefrologia. São Paulo, SP, Brasil
| | - Ubiratan de Paula Santos
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Bicarbonate : de la physiologie aux applications thérapeutiques pour tout clinicien. Nephrol Ther 2018; 14:13-23. [DOI: 10.1016/j.nephro.2017.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 02/22/2017] [Indexed: 11/17/2022]
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Abstract
OBJECTIVES Rhabdomyolysis is a disorder of muscle breakdown. The aim of this study was to describe the epidemiology of rhabdomyolysis in children admitted to a PICU and to assess the relationship between peak creatinine kinase and mortality. DESIGN Retrospective cohort study in children admitted to the PICU with rhabdomyolysis between January 1, 2005, and December 31, 2014. Demographic, clinical, and outcome data were recorded. Outcomes were analyzed by level of peak creatinine kinase value (0-10,000, 10,001-50,000, > 50,000IU/L). Long-term renal outcomes were reported for PICU survivors. SETTING A single-centre academic tertiary PICU. PATIENTS Children admitted to the PICU with serum creatinine kinase level greater than 1,000 IU/L. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS There were 182 children with rhabdomyolysis. The median peak creatinine kinase value was 3,583 IU/L (1,554-9,608). The primary diagnostic categories included sepsis, trauma, and cardiac arrest. Mortality for peak creatinine kinase values 0-10,000, 10,001-50,000, and > 50,000 IU/L were 24/138 (17%), 6/28 (21%), and 3/16 (19%), respectively (p = 0.87). Children with a peak creatinine kinase greater than 10,000 IU/L had a longer duration of mechanical ventilation and ICU length of stay than children with peak creatinine kinase less than 10,000. Renal replacement therapy was administered in 29/182 (16%). There was longer duration of mechanical ventilation (273 [141-548] vs. 73 [17-206] hr [p < 0.001]) and ICU length of stay (334 [147-618] vs. 100 [37-232] hr (p < 0.001)] in children receiving renal replacement therapy. Continuous veno-venous hemofiltration was the most common modality 23/29 (79%). Only one child required renal replacement therapy postintensive care stay, and adverse long-term renal outcomes were uncommon. CONCLUSIONS In children with rhabdomyolysis requiring intensive care, peak creatinine kinase was not associated with mortality but is associated with greater use of intensive care resources. Chronic kidney disease is an uncommon sequelae of rhabdomyolysis in children requiring intensive care.
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Ramirez-Lee MA, Aguirre-Bañuelos P, Martinez-Cuevas PP, Espinosa-Tanguma R, Chi-Ahumada E, Martinez-Castañon GA, Gonzalez C. Evaluation of cardiovascular responses to silver nanoparticles (AgNPs) in spontaneously hypertensive rats. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2017; 14:385-395. [PMID: 29175596 DOI: 10.1016/j.nano.2017.11.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 10/02/2017] [Accepted: 11/15/2017] [Indexed: 12/31/2022]
Abstract
Silver nanoparticles (AgNPs) are used in the medical, pharmaceutical and food industry. Adverse effects and toxicity induced by AgNPs upon cardiac function related to nitric oxide (NO) and oxidative stress (OS) are described. AgNPs-toxicity may be influenced by cardiovascular pathologies such as hypertension. However, the molecules involved under pathophysiological conditions are not well studied. The aim of this work was to evaluate perfusion pressure (PP) and left ventricle pressure (LVP) as physiological parameters of cardiovascular function in response to AgNPs, using isolated perfused hearts from spontaneously hypertensive rats (SHR), and identify the role of NO and OS. The results suggest that AgNPs reduced NO derived from endothelial/inducible NO-synthase and increased OS, leading to increased and sustained vasoconstriction and myocardial contractility. Additionally, the hypertension condition alters phenylephrine (Phe) and acetylcholine (ACh) classic effects. These data suggest that hypertension intensified AgNPs-cardiotoxicity. Nevertheless, the precise mechanism of action is still under elucidation.
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Affiliation(s)
| | - Patricia Aguirre-Bañuelos
- Facultad de Ciencias Quimicas, Universidad Autonoma de San Luis Potosi, San Luis Potosi, S.L.P., Mexico
| | | | | | - Erika Chi-Ahumada
- Facultad de Medicina, Universidad Autonoma de San Luis Potosi, San Luis, S.L.P., Mexico
| | | | - Carmen Gonzalez
- Facultad de Ciencias Quimicas, Universidad Autonoma de San Luis Potosi, San Luis Potosi, S.L.P., Mexico.
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Alaygut D, Torun Bayram M, Kasap B, Soylu A, Türkmen M, Kavukcu S. Rhabdomyolysis with different etiologies in childhood. World J Clin Pediatr 2017; 6:161-168. [PMID: 29184760 PMCID: PMC5691034 DOI: 10.5409/wjcp.v6.i4.161] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 07/11/2017] [Accepted: 07/21/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate different etiologies and management of the rhabdomyolysis in children. METHODS Eight pediatric rhabdomyolysis cases who applied to the Dokuz Eylul University Faculty of Medicine Department of Pediatric Nephrology with different etiologies between January 2004 and January 2012 were evaluated in terms of age, gender, admission symptoms, physical examination findings, factors provoking rhabdomyolysis, number of rhabdomyolysis attacks, laboratory results, family history and the final diagnosis received after the treatment. RESULTS Average diagnosis ages of eight cases were 129 (24-192) ± 75.5 mo and five of them were girls. All of them had applied with the complaint of muscle pain, calf pain, and dark color urination. Infection (pneumonia) and excessive physical activity were the most important provocative factors and excessive licorice consumption was observed in one case. In 5 cases, acute kidney injury was determined and two cases needed hemodialysis. As a result of the further examinations; the cases had received diagnoses of rhabdomyolysis associated with mycoplasma pneumoniae, sepsis associated rhabdomyolysis, licorice-induced hypokalemic rhabdomyolysis, carnitine palmitoyltransferase II deficiency, very long-chain acyl-CoA dehydrogenase deficiency, congenital muscular dystrophy and idiopathic paroxysmal rhabdomyolysis (Meyer-Betz syndrome). CONCLUSION It is important to distinguish the sporadic and recurrent rhabdomyolysis cases from each other. Recurrent rhabdomyolysis cases should follow up more regardful and attentive.
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Affiliation(s)
- Demet Alaygut
- Department of Pediatric Nephrology, Dokuz Eylul University Faculty of Medicine, 35340 İnciralti İzmir, Turkey
| | - Meral Torun Bayram
- Department of Pediatric Nephrology, Dokuz Eylul University Faculty of Medicine, 35340 İnciralti İzmir, Turkey
| | - Belde Kasap
- Department of Pediatric Nephrology, Dokuz Eylul University Faculty of Medicine, 35340 İnciralti İzmir, Turkey
| | - Alper Soylu
- Department of Pediatric Nephrology, Dokuz Eylul University Faculty of Medicine, 35340 İnciralti İzmir, Turkey
| | - Mehmet Türkmen
- Department of Pediatric Nephrology, Dokuz Eylul University Faculty of Medicine, 35340 İnciralti İzmir, Turkey
| | - Salih Kavukcu
- Department of Pediatric Nephrology, Dokuz Eylul University Faculty of Medicine, 35340 İnciralti İzmir, Turkey
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oğuz S, Tuygun N, Karacan CD. Enalapril ve essitalopram ile özkıyım girişimi sonrası gelişen rabdomiyoliz. EGE TIP DERGISI 2017. [DOI: 10.19161/etd.393483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Nakaoka S, Kawasaki Y, Inomata S, Makimoto M, Yoshida T. Caffeine Toxicity in a Preterm Neonate. Pediatr Neonatol 2017; 58:380-381. [PMID: 27742225 DOI: 10.1016/j.pedneo.2016.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/27/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
- Sachiko Nakaoka
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, Toyama, Japan
| | - Yukako Kawasaki
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, Toyama, Japan
| | - Satomi Inomata
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, Toyama, Japan
| | - Masami Makimoto
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, Toyama, Japan
| | - Taketoshi Yoshida
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, Toyama, Japan.
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Ramirez-Lee MA, Espinosa-Tanguma R, Mejía-Elizondo R, Medina-Hernández A, Martinez-Castañon GA, Gonzalez C. Effect of silver nanoparticles upon the myocardial and coronary vascular function in isolated and perfused diabetic rat hearts. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2017; 13:2587-2596. [PMID: 28756091 DOI: 10.1016/j.nano.2017.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/04/2017] [Accepted: 07/13/2017] [Indexed: 11/26/2022]
Abstract
Silver nanoparticles (AgNPs) are promising antibacterial nanomaterials for diagnostic and treatment of diabetes. However, toxicity and adverse cardiac responses induced by AgNPs related to nitric oxide (NO) and oxidative stress (OS) are described. Moreover, little is known about the diabetes influence upon AgNPs-toxicity. The aim of this work was to evaluate cardiovascular function in response to AgNPs through measuring perfusion pressure (PP) and left ventricle pressure (LVP), using perfused hearts from streptozotocin (STZ)-induced diabetic rats and identify the role of NO and OS. High concentrations but not the lower concentrations of AgNPs, promotes increases in PP and LVP, as well as increased OS. Additionally, diabetes alters the classic effects of phenylephrine (Phe) and acetylcholine (ACh). These data suggest that diabetes may intensify AgNPs-cardiotoxicity. Nevertheless, the precise mechanism of action is still under elucidation.
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Affiliation(s)
- Manuel Alejandro Ramirez-Lee
- Facultad de Ciencias Quimicas, Universidad Autonoma de San Luis Potosi, Av. Manuel Nava Num. 6, Col. Universitaria, San Luis Potosi, S.L.P., Mexico
| | - Ricardo Espinosa-Tanguma
- Facultad de Medicina, Universidad Autonoma de San Luis Potosi, Av. Venustiano Carranza 2405, Los Filtros, San Luis, S.L.P., Mexico
| | - Rebeca Mejía-Elizondo
- Facultad de Medicina, Universidad Autonoma de San Luis Potosi, Av. Venustiano Carranza 2405, Los Filtros, San Luis, S.L.P., Mexico
| | - Alejandra Medina-Hernández
- Facultad de Medicina, Universidad Autonoma de San Luis Potosi, Av. Venustiano Carranza 2405, Los Filtros, San Luis, S.L.P., Mexico
| | - Gabriel Alejandro Martinez-Castañon
- Facultad de Estomatologia, Universidad Autonoma de San Luis Potosi, Av. Manuel Nava Num. 2, Col. Universitaria, San Luis Potosi, S.L.P., Mexico
| | - Carmen Gonzalez
- Facultad de Ciencias Quimicas, Universidad Autonoma de San Luis Potosi, Av. Manuel Nava Num. 6, Col. Universitaria, San Luis Potosi, S.L.P., Mexico.
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Evaluation of vascular tone and cardiac contractility in response to silver nanoparticles, using Langendorff rat heart preparation. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2017; 13:1507-1518. [DOI: 10.1016/j.nano.2017.01.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/24/2017] [Accepted: 01/30/2017] [Indexed: 11/20/2022]
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Change in iron metabolism in rats after renal ischemia/reperfusion injury. PLoS One 2017; 12:e0175945. [PMID: 28426710 PMCID: PMC5398610 DOI: 10.1371/journal.pone.0175945] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 04/03/2017] [Indexed: 12/21/2022] Open
Abstract
Previous studies have indicated that hepcidin, which can regulate iron efflux by binding to ferroportin-1 (FPN1) and inducing its internalization and degradation, acts as the critical factor in the regulation of iron metabolism. However, it is unknown whether hepcidin is involved in acute renal ischemia/reperfusion injury (IRI). In this study, an IRI rat model was established via right renal excision and blood interruption for 45 min in the left kidney, and iron metabolism indexes were examined to investigate the change in iron metabolism and to analyze the role of hepcidin during IRI. From 1 to 24 h after renal reperfusion, serum creatinine and blood urea nitrogen were found to be time-dependently increased with different degrees of kidney injury. Regular variations in iron metabolism indexes in the blood and kidneys were observed in renal IRI. Renal iron content, serum iron and serum ferritin increased early after reperfusion and then declined. Hepcidin expression in the liver significantly increased early after reperfusion, and its serum concentration increased beginning at 8 h after reperfusion. The splenic iron content decreased significantly in the early stage after reperfusion and then increased time-dependently with increasing reperfusion time, and the hepatic iron content showed a decrease in the early stage after reperfusion. The early decrease of the splenic iron content and hepatic iron content might indicate their contribution to the increase in serum iron in renal IRI. In addition, the duodenal iron content showed time-dependently decreased since 12 h after reperfusion in the IRI groups compared to the control group. Along with the spleen, the duodenum might contribute to the decrease in serum iron in the later stage after reperfusion. The changes in iron metabolism indexes observed in our study demonstrate an iron metabolism disorder in renal IRI, and hepcidin might be involved in maintaining iron homeostasis in renal IRI. These findings might suggest a self-protection mechanism regulating iron homeostasis in IRI and provide a new perspective on iron metabolism in attenuating renal IRI.
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Abstract
Rhabdomyolysis, which is a characteristic occurrence in associated with muscle cell necrosis, develops due to various causes. We herein report a rare case of a patient with rhabdomyolysis after high intensity resistance training, in which markedly elevated levels of serum creatine kinase (CK) and urine myoglobin were observed. A previously healthy 37-year-old man presented with severe myalgia and dark urine after performing high-intensity exercise. The patient's serum CK level was 95,100 U/L and his urine myoglobin level was 160,000 ng/mL. His symptoms and laboratory findings gradually improved with the intravenous administration of saline and no complications (including electrolyte imbalance and acute renal failure) developed.
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Affiliation(s)
- Sakiko Honda
- Department of Cardiology, Matsushita Memorial Hospital, Japan
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31
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Yang Y, Carter LP, Cook RE, Paul E, Schwartz KR. A Case of Exertional Rhabdomyolysis: A Cheer for Standardizing Inpatient Management and Prevention. Hosp Pediatr 2016; 6:753-756. [PMID: 27909094 DOI: 10.1542/hpeds.2016-0082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
| | - Lindsay P Carter
- Department of Pediatrics, and.,Divisions of Pediatric Hospital Medicine
| | - Rebecca E Cook
- Department of Pediatrics, and.,Divisions of Pediatric Hospital Medicine
| | - Elahna Paul
- Department of Pediatrics, and.,Pediatric Nephrology, and
| | - Kevin R Schwartz
- Department of Pediatrics, and.,Divisions of Pediatric Hospital Medicine.,Pediatric Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Jiang W, Wang X, Zhou S. Rhabdomyolysis induced by antiepileptic drugs: characteristics, treatment and prognosis. Expert Opin Drug Saf 2016; 15:357-65. [DOI: 10.1517/14740338.2016.1139572] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Altun D, Kurekci AE, Gursel O, Hacıhamdioglu DO, Kurt I, Aydın A, Ozcan O. Malondialdehyde, antioxidant enzymes, and renal tubular functions in children with iron deficiency or iron-deficiency anemia. Biol Trace Elem Res 2014; 161:48-56. [PMID: 25099508 DOI: 10.1007/s12011-014-0084-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 07/15/2014] [Indexed: 12/15/2022]
Abstract
We aimed to investigate the effects of iron deficiency (ID) or iron-deficiency anemia (IDA) on oxidative stress and renal tubular functions before and after treatment of children. A total of 30 children with a diagnosis of IDA constituted the IDA group and 32 children with a diagnosis of ID constituted the ID group. Control group consisted 38 age-matched children. Serum ferritin, soluble transferrin receptor (sTfR), serum, and urinary sodium (Na), potassium (K), calcium (Ca), phosphorus (P), creatinine (Cr), uric acid (UA), urinary N-acetyl-β-D-glucosaminidase (NAG) levels, and intra-erythrocyte malondialdehyde (MDA), catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) levels were measured before and after iron therapy in the IDA and ID groups, whereas it was studied once in the control group. We have divided the study group in groups according to age (infants <2 years, children 3-9 years, and adolescents 10-15 years). Patients with IDA (infant, adolescent) and ID (infant, children, and adolescent) had a significantly high level of MDA in post-treatment period in comparison to those of healthy control. Patients with IDA (children, adolescent) and ID (infant, children) had a significantly high level of pre-treatment GSH-Px than controls. Post-treatment SOD was lower in IDA (children and adolescent) groups than control and post-treatment CAT was lower in IDA and ID (adolescent) groups than control. These findings show that ferrous sulfate used in the treatment of ID or IDA could lead to oxidative stress; however, a marked deterioration of in proximal renal tubular functions was not seen.
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Affiliation(s)
- Demet Altun
- Department of Pediatrics, Gulhane Military Medical Academy and Medical Faculty, Ankara, Turkey
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Zutt R, van der Kooi AJ, Linthorst GE, Wanders RJA, de Visser M. Rhabdomyolysis: review of the literature. Neuromuscul Disord 2014; 24:651-9. [PMID: 24946698 DOI: 10.1016/j.nmd.2014.05.005] [Citation(s) in RCA: 248] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/02/2014] [Accepted: 05/13/2014] [Indexed: 12/18/2022]
Abstract
Rhabdomyolysis is a serious and potentially life threatening condition. Although consensus criteria for rhabdomyolysis is lacking, a reasonable definition is elevation of serum creatine kinase activity of at least 10 times the upper limit of normal followed by a rapid decrease of the sCK level to (near) normal values. The clinical presentation can vary widely, classical features are myalgia, weakness and pigmenturia. However, this classic triad is seen in less than 10% of patients. Acute renal failure due to acute tubular necrosis as a result of mechanical obstruction by myoglobin is the most common complication, in particular if sCK is >16.000 IU/l, which may be as high as 100,000 IU/l. Mortality rate is approximately 10% and significantly higher in patients with acute renal failure. Timely recognition of rhabdomyolysis is key for treatment. In the acute phase, treatment should be aimed at preserving renal function, resolving compartment syndrome, restoring metabolic derangements, and volume replacement. Most patients experience only one episode of rhabdomyolysis, mostly by substance abuse, medication, trauma or epileptic seizures. In case of recurrent rhabdomyolysis, a history of exercise intolerance or a positive family history for neuromuscular disorders, further investigations are needed to identify the underlying, often genetic, disorder. We propose a diagnostic algorithm for use in clinical practice.
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Affiliation(s)
- R Zutt
- Department of Neurology, Academic Medical Center, University of Amsterdam/University Medical Center Groningen, The Netherlands
| | - A J van der Kooi
- Department of Neurology, Academic Medical Center, University of Amsterdam, The Netherlands.
| | - G E Linthorst
- Department of Internal Medicine/Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, The Netherlands
| | - R J A Wanders
- Department of Paediatrics and Clinical Chemistry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - M de Visser
- Department of Neurology, Academic Medical Center, University of Amsterdam, The Netherlands
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Neuropsychiatric adverse events associated with statins: epidemiology, pathophysiology, prevention and management. CNS Drugs 2014; 28:249-72. [PMID: 24435290 DOI: 10.1007/s40263-013-0135-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Statins, or 3-hydroxy-3-methyl-glutaryl coenzyme A reductase inhibitors, such as lovastatin, atorvastatin, simvastatin, pravastatin, fluvastatin, rosuvastatin and pitavastatin, are cholesterol-lowering drugs used in clinical practice to prevent coronary heart disease. These drugs are generally well tolerated and have been rarely associated with severe adverse effects (e.g. rhabdomyolysis). Over the years, case series and data from national registries of spontaneous adverse drug reaction reports have demonstrated the occurrence of neuropsychiatric reactions associated with statin treatment. They include behavioural alterations (severe irritability, homicidal impulses, threats to others, road rage, depression and violence, paranoia, alienation, antisocial behaviour); cognitive and memory impairments; sleep disturbance (frequent awakenings, shorter sleep duration, early morning awakenings, nightmares, sleepwalking, night terrors); and sexual dysfunction (impotence and decreased libido). Studies designed to investigate specific neuropsychiatric endpoints have yielded conflicting results. Several mechanisms, mainly related to inhibition of cholesterol biosynthesis, have been proposed to explain the detrimental effects of statins on the central nervous system. Approaches to prevent and manage such adverse effects may include drug discontinuation and introduction of dietary restrictions; maintenance of statin treatment for some weeks with close patient monitoring; switching to a different statin; dose reduction; use of ω-3 fatty acids or coenzyme Q10 supplements; and treatment with psychotropic drugs. The available information suggests that neuropsychiatric effects associated with statins are rare events that likely occur in sensitive patients. Additional data are required, and further clinical studies are needed.
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36
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Abstract
Creatine kinase (CK) plays an important role in cellular energy metabolism in various tissues and skeletal muscle is recognized as being the largest reservoir of this enzyme. Elevated CK levels can be induced by various harmless or severe conditions implying multiple differential diagnoses for the physician. Trauma, inflammation, drug-induced toxicity, genetic disorders as well as metabolic, endocrine or rheumatic diseases might lead to cell degeneration and leakage of CK and other cellular components. Massive destruction of muscular tissue leads to rhabdomyolysis, defined as CK elevation combined with organ damage, which requires immediate diagnostic and therapeutic intervention.
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Affiliation(s)
- P Lehmann
- Klinik für Rheumatologie/Klinische Immunologie, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077 Bad Abbach, Deutschland.
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Matsuzaki H, Koga Y, Suminoe A, Oba U, Takimoto T, Hara T. Severe acute rhabdomyolysis induced by multi-agent chemotherapy for alveolar rhabdomyosarcoma in a 15-year-old female: a case report. Case Rep Oncol 2013; 6:397-402. [PMID: 24019778 PMCID: PMC3764948 DOI: 10.1159/000354271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
This is the first paper to report the association of cancer chemotherapy with rhabdomyolysis in children. A previously healthy, 15-year-old Japanese female was diagnosed as having alveolar rhabdomyosarcoma. She received the first cycle of multi-agent chemotherapy without any adverse effects. However, she developed severe acute rhabdomyolysis shortly after the second cycle of multi-agent chemotherapy, which consisted of etoposide, ifosfamide, actinomycin-D and vincristine. Her condition deteriorated rapidly and she was treated with mechanical ventilation and fluid replacement. After further evaluation, anticancer drugs were thought to be responsible for the rhabdomyolysis.
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Affiliation(s)
- Hiroshi Matsuzaki
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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38
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Martines AMF, Masereeuw R, Tjalsma H, Hoenderop JG, Wetzels JFM, Swinkels DW. Iron metabolism in the pathogenesis of iron-induced kidney injury. Nat Rev Nephrol 2013; 9:385-98. [DOI: 10.1038/nrneph.2013.98] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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39
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Guzman N, Podoll AS, Bell CS, Finkel KW. Myoglobin Removal Using High-Volume High-Flux Hemofiltration in Patients with Oliguric Acute Kidney Injury. Blood Purif 2013; 36:107-11. [DOI: 10.1159/000354727] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 07/27/2013] [Indexed: 12/18/2022]
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40
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Martínez López A, Hidalgo Cebrián R, Rivas García A. Otras causas de dolor abdominal: rabdomiólisis aguda en relación con el ejercicio físico. An Pediatr (Barc) 2012; 77:352-3. [DOI: 10.1016/j.anpedi.2012.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 04/12/2012] [Indexed: 10/28/2022] Open
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