Acute Kidney Injury with Rhabdomyolysis: 25 Years Experience from a Tertiary Care Center

Abstract

Objective: To describe patients presenting with acute kidney injury after rhabdomyolysis at a tertiary renal care center in Pakistan. Patients and Methods: An observational cohort of patients identified as having acute kidney injury (AKI) with rhabdomyolysis, which was diagnosed by rise in creatinine phosphokinase (CK) and lactate dehydrogenase (LDH) more than 4 times the reference range whereas AKI was defined according to RIFLE criteria. On ultrasonography, all patients had normal size non obstructed kidneys, and no other co morbid. Results: Between January1990 to December 2014, 334 patients with rhabdomyolysis and AKI registered to this hospital. Mean age was 28.22 ± 11.22 years with M:F ratio of 3.33:1. Mean values of CK and LDH were 597,749.790 ± 180,461.360 and 4077.026 ± 5050.704 U/L with reference range of 26 - 174 U/L and 91 - 180 U/L respectively. We divided the study population into 4 groups over timeline. Rhabdomyolysis etiology was divided in 3 groups; 1) traumatic, 2) non-traumatic exertional, and 3) non-traumatic non-exertional. In the last group, which spans from 2010-2014, we treated many cases with toxic rhabdomyolysis and main toxin was paraphenylenediamine (PPD). The other causes showed more or less same prevalence over two and a half decade, except non-traymatic exertional which has decreased during last 5 years without any explainable cause. Renal replacement therapy (RRT) was required on arrival in 94% cases. Complete renal recovery was observed in 70%, while 15.86% died and 10% were lost during recovery phase. A small number 2.69% left against medical advice during acute phase of illness and 0.8% developed chronic kidney disease (CKD). Conclusion: The common clinical conditions found associated with rhabdomyolysis and AKI includes trauma, immobilization, sepsis, overexertion, and drugs and toxins. In recent years, we have seen many young patients with PPD poisoning; we have found good renal recovery in patients who survived initial 2 - 3 weeks.