Abstract
Rhabdomyolysis is a syndrome characterized by the breakdown of skeletal muscle and
leakage of intracellular myocyte contents, such as creatine phosphokinase (CPK) and
myoglobin, into the interstitial space and plasma resulting in acute kidney injury
(AKI). Elevated CPK of at least 5 times the upper limit of normal is an important
diagnostic marker of Rhabdomyolysis. We present a case of rhabdomyolysis with severe
AKI with a normal CPK at presentation. A 32-year-old man presented with acute respiratory
failure and AKI after an overdose of recreational drugs. Urinalysis at presentation
showed trace amounts of blood, identified as rare red blood cells under microscopy.
CPK was 156 U/L at presentation. Workup for glomerulonephritis and vasculitis was
negative. He was initiated on renal replacement therapy, and a kidney biopsy showed
severe acute tubular injury with positive myoglobin casts. Supportive management and
renal replacement therapy was provided, and renal function spontaneously improved
after a few weeks. This is an uncommon clinical presentation of severe rhabdomyolysis
complicated by AKI. This suggests that CPK alone may not be a sensitive marker for
rhabdomyolysis-induced AKI in some cases.
Key Indexing Terms
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Article info
Publication history
Published online: May 08, 2017
Accepted:
April 18,
2017
Received:
February 5,
2017
Footnotes
☆The authors have no financial or other conflicts of interest to disclose.
Identification
Copyright
© 2017 Southern Society for Clinical Investigation. Published by All rights reserved.
