Vnitr Lek 2023, 69(8):488-493 | DOI: 10.36290/vnl.2023.098

Unusual presentation of rhabdomyolysis

Kristína Liachovická, Věra Sztuchlíková, Lucie Lysková, Jiří Orság, Zdenka Kosatíková, Miroslav Hrubý, Jiří Vymětal, Karel Krejčí

III. interní klinika - nefrologická, revmatologická a endokrinologická, Fakultní nemocnice Olomouc

Rhabdomyolysis is a potentially life-threatening syndrome characterized by necrosis of muscle cells and release of intracellular contents into the circulation. Acute kidney injury represents one of its most serious complications. The detection of the causative factor requires considerable diagnostic effort in some cases, as documented in the case report. The basis of therapy, in addition to affecting the cause itself, is early and relatively aggressive rehydration therapy. In the most severe cases, replacement of renal function is necessary, guided by renal indications. However, elimination of myoglobin itself is insufficient in conventional dialysis (even with the use of high-flux dialysis membranes) due to its molecular size (17kDa). The use of innovative dialysis membranes permeable to higher molecular weight substances, the so-called medium cut-off (MCO) or high cut-off (HCO) membranes, has become an important step towards improving myoglobin elimination in rhabdomyolysis. In the case of the described patient, their use was a key moment in the attempt to reverse acute kidney injury with oliguria, hypervolaemia and other accompanying complications. There was a significant decrease in circulating myoglobin, rapid improvement in renal function and overall clinical status.

Keywords: acute kidney injury, dialysis, high cut­‑off membrane, hydration, medium cut­‑off membrane, rhabdomyolysis.

Accepted: November 27, 2023; Published: December 18, 2023  Show citation