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.
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- Acute kidney injury due to rhabdomyolysis.Saudi J Kidney Dis Transpl. 2008; 19: 721-729
- Rhabdomyolysis: an evaluation of 475 hospitalized patients.Medicine (Baltimore). 2005; 84: 377-385
- Bench-to-bedside review: rhabdomyolysis—an overview for clinicians.Crit Care. 2005; 9: 158-169
- Pathogenesis and treatment of renal dysfunction in rhabdomyolysis.Intensive Care Med. 2001; 27: 803-811
- Rhabdomyolysis.Intern Emerg Med. 2007; 2: 210-218
- Rhabdomyolysis and acute kidney injury.N Engl J Med. 2009; 361: 62-72
- Relationship between elevated creatine phosphokinase and the clinical spectrum of rhabdomyolysis.Nephrol Dial Transplant. 1994; 9: 637-641
- Serum creatine kinase as predictor of clinical course in rhabdomyolysis: a 5-year intensive care survey.Intensive Care Med. 2003; 29: 1121-1125
- Prognostic value, kinetics and effect of CVVHDF on serum of the myoglobin and creatine kinase in critically ill patients with rhabdomyolysis.Acta Anaesthesiol Scand. 2005; 49: 859-864
- Rapid fall in blood myoglobin in massive rhabdomyolysis and acute renal failure.Intensive Care Med. 1994; 20: 109-112
- Creatinine as predictor value of mortality and acute kidney injury in rhabdomyolysis.Intern Med J. 2015; 45: 1173-1178
- Early management of shock and prophylaxis of acute renal failure in traumatic rhabdomyolysis.N Engl J Med. 1990; 322: 825-829
- Prophylaxis of acute renal failure in patients with rhabdomyolysis.Ren Fail. 1997; 19: 283-288
- Preventing renal failure in patients with rhabdomyolysis: do bicarbonate and mannitol make a difference?.J Trauma. 2004; 56: 1191-1196
- Oral alkalinizing solution as a potential prophylaxis against myoglobinuric acute renal failure: preliminary data from healthy volunteers.Nephrol Dial Transplant. 2005; 20: 1228-1231
- Myoglobin clearance by super high-flux hemofiltration in a case of severe rhabdomyolysis: a case report.Crit Care. 2005; 9: R90-R95
- High cut-off membrane hemodiafiltration in myoglobinuric acute renal failure: a case series.Ther Apher Dial. 2011; 15: 287-291
- Clearance of myoglobin by high cutoff continuous veno-venous hemodialysis in a patient with rhabdomyolysis: a case report.Hemodial Int. 2015; 19: 135-140
Published online: May 08, 2017
Accepted: April 18, 2017
Received: February 5, 2017
☆The authors have no financial or other conflicts of interest to disclose.
© 2017 Southern Society for Clinical Investigation. Published by All rights reserved.