Downer cow syndrome causing rhabdomyolysis and acute renal failure in a 17-month-old Guzerá heifer / Síndrome da vaca caída causando rabdomiólise e insuficiência renal aguda em uma novilha Guzerá de 17 meses

The downer cow syndrome (DCS) is characterized by an alert cow showing inability or reluctance to stand for 12 hours or more. This paper reported clinical, laboratory, and pathological findings in a Guzerá heifer with rhabdomyolysis, pigmenturia and acute renal failure following DCS. A 17-month-old Guzerá heifer was transported via a 350-km ride in a truck and showed sternal recumbency and severe difficulty in standing and walking. Neurological examination was unremarkable, and the heifer presented normal response to cranial nerves and spinal cord tests. Rectal palpation revealed a 5-month gravid uterus. No other abnormalities were noted in the pelvis or around the coxofemoral joints. Biochemical abnormalities included extremely high muscular enzyme activities (creatine phosphokinase and aspartate aminotransferase) and high creatinine levels. Urinalysis revealed blackish and cloudy urine, proteinuria, and a positive occult blood test. Spinal cord ultrasonography showed no abnormalities. This report highlighted an uncommon clinical presentation (myoglobinuria) and pathological findings in a heifer with DCS as a consequence of severe compressive muscle damage. Practitioners and producers must be aware of the risk of careless road transportation for long distances of cattle, especially obese cows, avoiding unnecessary suffering and expenses due to DCS.

A síndrome da vaca caída (SVC) é caracterizada por um bovino alerta que mostra incapacidade ou relutância em permanecer em estação por 12 horas ou mais. O objetivo deste trabalho é relatar os achados clínicos, laboratoriais e patológicos em uma novilha Guzerá com rabdomiólise, pigmentúria e insuficiência renal aguda após a SVC. Uma novilha da raça Guzerá, de 17 meses de idade, foi transportada de caminhão por 350 km e apresentou decúbito esternal, grande dificuldade para assumir estação e caminhar. O exame neurológico não demonstrou alterações, e a novilha possuía resposta normal aos testes de nervos cranianos e medula espinhal. A palpação retal revelou útero grávido de cinco meses. Nenhuma outra anormalidade foi observada na pelve ou na região das articulações coxofemorais. As anormalidades bioquímicas incluíram atividades de enzimas musculares (creatina fosfoquinase e aspartato aminotransferase) extremamente aumentadas e níveis elevados de creatinina. A urinálise revelou urina enegrecida e turva, proteinúria e teste de sangue oculto positivo. O exame ultrassonográfico da medula espinhal não apresentou anormalidades. Este relato evidencia uma apresentação clínica (mioglobinúria) e achados patológicos incomuns em uma novilha com SVC em consequência de extensa lesão muscular compressiva. Veterinários e produtores devem estar atentos aos riscos do transporte rodoviário descuidado por longas distâncias de bovinos, especialmente vacas obesas, evitando assim sofrimento e despesas desnecessárias decorrentes da SVC.

Rhabdomyolysis with acute kidney injury after single episode of generalized seizure in a known case of epilepsy: a case report

Rhabdomyolysis is defined as breakdown of skeletal muscle fibers with subsequent release of its cellular components into the circulation. It is associated with variety of causes and status epilepticus is one of it. The excessive muscular activity associated with seizure is possible explanation for it. It is clinically evident by the new onset severe generalized bodyache, weakness and myalgia associated with dark coloured urine. Acute kidney injury is one of the most serious complications associted with rhabdomyolysis. Single episode of generalized seizure is not a frequent cause for rhabdomyolysis. Acute kidney injury due to rhabdomyolysis, following a single episode of seizure is a rare entity. Here we report a case of rhabdomyolysis with acute kidney injury following a single episode of generalized seizure. High index of suspicion is required to timely diagnose and treat such patients. Timely intervention with hemodialysis along with other supportive care can completely revert this potentially serious complication to normal.

The curative effects of methylsulfonylmethane against glycerol-induced acute renal failure in rats

Abstract The present study was performed to explore the curative effect of Methylsulfonylmethane (MSM) in an experimental model of myoglobinuric acute renal failure (ARF). In this experimental model, Rats were injected with 50% glycerol (10 mL/kg, im) followed by an hour later and daily in the next six days by MSM (400 mg/kg) or saline. Kidney's function (urea and creatinine), and reduced glutathione were analyzed. A renal failure produced by glycerol injection, with a significant increase of blood urea and serum creatinine was observed. Rats that received MSM in addition to glycerol had significantly lower blood urea and serum creatinine levels compared to those receiving glycerol alone. However, glutathione has markedly increased after MSM treatment. The effect is probably due to the antioxidant activity of MSM. This may provide therapeutic opportunities for treating humans, myoglobinuric ARF.

Rabdomiólisis en la primera semana de entrenamiento. reporte de dos casos / Rhabdomyolysis at the first week of training. two cases report / Rabdomiólise na primeira semana de treinamento. relato de dois casos

La rabdomiólisis es un síndrome causado por lesión al músculo estriado con liberación de contenido celular muscular a la circulación, puede causar acidosis láctica, hiperfosfatemia, coagulación intravascular diseminada, hiperkalemia, síndrome compartimental, falla renal, e incluso puede comprometer la vida del paciente. La triada de síntomas incluye mialgias, debilidad y como manifestación cardinal orina de color rojoachocolatado, frente a lo cual se debe establecer diagnóstico diferencial ante la aparente eritrocituria e interrogarse sobre el uso de fármacos que enrojezcan la orina. El desconocimiento clínico y la demora diagnóstica, retardan el tratamiento específico incrementando así la morbimortalidad. El diagnóstico se puede confirmar ágilmente demostrando niveles elevados de: creatinina fosfoquinasa (CPK) sérica, análisis metabólicos, mioglobinuria, análisis de las enzimas intracelulares transaminasa glutámicooxalacético/ aspartato aminotransferasa (GOT/ASAT), transaminasa glutámico pirúvico/alanino aminotransferasa (GPT/ALAT). El tratamiento está encauzado a acelerar la recuperación, identificar y corregir cualquier causa reversible de lesión muscular al igual que prevenir y tratar las complicaciones, la infusión oportuna y agresiva de cristaloides es el pilar del tratamiento, el uso de manitol, bicarbonato y antioxidantes aún es controvertido. En este reporte de casos se muestran las manifestaciones clínicas típicas de rabdomiólisis en dos hombres durante la primera semana de entrenamiento, en quienes se precipitó esta condición por deshidratación, actividad física intensa, inadecuada vestimenta y exposición a temperatura ambiental elevada (mayor a 25°C). Estos pacientes fueron rápidamente diagnosticados, y recibieron tratamiento oportuno por lo que no presentaron complicaciones, actualmente están asintomáticos.

Rhabdomyolysis is a syndrome caused by breakdown of skeletal muscle with release of muscle cell contents into the bloodstream, may cause lactic acidosis, hyperphosphatemia, disseminated intravascular coagulation, hyperkalemia, compartment syndrome, renal failure, and may even jeopardize the patient's life. The triad of symptoms including myalgia, weakness and urine - chocolate - red color as a cardinal manifestation, against which must be set before the differential diagnosis erythrocyturia apparent and question the use of drugs that turn red urine. Clinical ignorance and delay in diagnosis slow down specific treatment. The diagnosis can be confirmed swiftly demonstrating elevated levels of serum creatine phosphokinase (CPK), metabolic analysis, myoglobinuria, analysis of intracellular glutamic oxaloacetic transaminase/aspartate aminotransferase enzymes (ALT/AST), glutamic pyruvic transaminase/alanine aminotransferase (GPT/ALAT). Treatment is aimed at accelerating recovery, identifying any reversible cause of muscle injury, prevent and treat complications, timely and aggressive crystalloid infusion is the mainstay of treatment, the use of mannitol, bicarbonate and antioxidants even is controversial. This case report shows the typical clinical manifestations of rhabdomyolysis in two men in the first week of training, in whom this condition was precipitated by dehydration, intense physical activity, inadequate clothing and exposure to high ambient temperature (above 25°C). These patients were quickly diagnosed and received timely treatment so no present any complications, actually they are asymptomatic.

A rabdomiólise é uma síndrome causada por lesão do músculo estriado com libertação do conteúdo das células musculares para a torrente sanguínea, a suas causas são acidose láctica, hiperfosfatemia, coagulação intravascular disseminada, hipercalemia, síndrome do compartimento, insuficiência renal, e pode mesmo comprometer a vida do paciente. A tríade de sintomas inclui mialgias, fraqueza e, como manifestação cardinal, urina de cor vermelho - achocolatado, por isso é preciso estabelecer um diagnostico diferencial ante a eritrocitária aparente e questionar sobre os medicamentos que tornam a urina vermelha. A ignorância clínica e atraso de diagnóstico retardam o tratamento específico aumentando assim a morbidade e mortalidade. O diagnóstico pode ser confirmado rapidamente demonstrando níveis elevados de: creatinina fosfoquinase (CPK), análises metabólicos, mioglobinúria, análises das enzimas intracelulares transaminase glutâmico-oxalacética/aspartato aminotransferase (TGO/AST), transaminase glutâmico pirúvica/alanina aminotransferase (TGP/ALT). O tratamento tem sido orientado para acelerar a recuperação, identificar e corrigir qualquer causa reversível de lesão muscular assim como prevenir e tratar complicações. A infusão oportuna e agressiva de cristaloides é a base do tratamento, a utilização de manitol, bicarbonato e antioxidantes é ainda controversa. Neste informe de casos se revelam as manifestações clinicas tipicas de rabdomiólise em dois homens durante a primeira semana treinamento, em eles foi manifestada esta condição por desidratação, atividade física intensa, roupas inadequadas e exposição ao ambiente de alta temperatura (superior a 25). Estes pacientes foram rapidamente diagnosticados e eles receberam um tratamento oportuno pelo qual eles não presentaram complicações e atualmente eles não têm nenhum sintoma.

Insuficiencia renal aguda inducida por mordedura de serpiente Bothrops / Acute renal failure induced by Bothrops snake bite

Mujer de 58 años de edad, remitida a urgencias por presentar cuadro clínico de insuficiencia renal aguda (IRA) secundaria a mordedura de serpiente (Bothrops Atrox). Ingresa hipotensa con elevación de azoados e hiperkalemia, ecografía renal dentro de parámetros normales. Se maneja terapia dialítica con lo cual presenta mejoría clínica. En este reporte se detallan aspectos del diagnóstico, manejo clínico y posibles mecanismos fisiopatológicos que explican el daño renal.

A 58 years old woman was referred to the emergency room with acute renal failure (ARF) having suffered a snake bite (Bothrops Atrox). On examination she was found with hypotension, elevated kidney function, hyperkalemia and a renal ultrasound with no abnormalities. Clinical improvement was achieved with dialytic therapy. In this report, certain aspects of the diagnosis are highlighted such as clinical management and possible pathophysiological mechanism of urderlying kidney damage.

Rabdomiolisis, mioglobinuria e injuria renal aguda inducida por el ejercicio: reporte de un caso en el Centro Médico Boliviano Belga / Rhabdomyolysis, myoglobinuria and acute renal injury induced by exercise: a case report in the Centro Médico Boliviano

La rabdomiólisis es un síndrome caracterizado por destrucción muscular y liberación de elementos intracelulares y en especial mioglobina del músculo dañado a la circulación. La injuria renal aguda es frecuente en la rabdomiólisis y resulta de la acción nefrotóxica del grupo hem de la mioglobina. Presentamos el caso de un joven con una enfermedad amenazante para la vida, asociada a elevaciones extremas de las enzimas musculares, trastornos hidroelectrolíticos potencialmente fatales y fallo renal agudo oligúrico como resultado de un ejercicio físico intenso a 3800 metros sobre el nivel del mar y revisamos la literatura acerca de esta interesante condición clínica.

Rhabdomiolisis is a syndrome characterized by muscle cell destruction and release of the intracellular content, and mainly myoglobin, into the blood. An acute kidney injury is common and due to the nephrotoxic action of the hem group of myoglobin. We present a young man with a life threatening illness, associated with an extreme elevation of muscle enzymes, potentially fatal electrolyte disorders and oliguric acute renal failure as a result of a vigorous exertion at 3.800 meters above sea level and review the literature about this interesting clinical condition.

Anesthesia-Induced Rhabdomyolysis During Corrective Spine Surgery: A Case Report.

We present a case in which a pediatric cerebral palsy patient developed intraoperative myoglobinuria and rhabdomyolysis with elevated creatine kinase (CK) during prone scoliosis surgery. A diagnosis of rhabdomyolysis was established with the finding of teacolored urine intraoperatively, and confirmed with elevated urine myoglobin and CK postoperatively. Cerebral palsy patients may develop anesthesia-induced rhabdomyolysis when inhalational anesthetics used.

Rabdomiolisis inducida por ejercicio en adolescentes chilenos / Exercise-induced rhabdomyolysis in Chilean adolescents

Rabdomiolisis es la destrucción de las fibras musculares y se caracteriza clínicamente por dolor, edema y debilidad muscular, orina color rojo-café (mioglobinuria) y la elevación por un corto período de la enzima creatinquinasa en sangre. Entre las múltiples causas de rabdomiolisis está el ejercicio intenso. La rabdomiolisis inducida por el ejercicio está escasamente documentada en la población pediátrica y en general requiere descartar alguna patología metabólica de base. Las complicaciones de la rabdomiolisis pueden ser múltiples y graves: falla renal, arritmias cardíacas, síndrome compartamental, coagulación intravascular diseminada, acidosis láctica, etc. La falla renal es consecuencia de la necrosis tubular aguda secundaria al taponamiento de los túbulos renales por la mioglobina, que puede llegar a ser fatal. Comunicamos nuestra experiencia con tres adolescentes que después de iniciar un programa de entrenamiento físico, desarrollaron intenso dolor y edema muscular constatándose un significativo aumento de la enzima creatinquinasa y edema muscular en la ultrasonografía de los músculos utilizados en el ejercicio. El estudio complementario descartó una patología metabólica de base en todos ellos. El tratamiento oportuno incluyó terapia sintomática e hidratación intravenosa. No se desarrolló insuficiencia renal en ninguno. Frente al incremento no controlado del entrenamiento físico, el diagnóstico oportuno de esta patología permite evitar sus graves consecuencias.

Rhabdomyolysis implies injury to the muscle fibers. The hallmark clinical manifestations are pain, oedema, muscle weakness and dark urine (myoglobinuria). There is an increase, for a short time, of the muscle enzyme creatine kinase in blood. Exercise induced rhabdomyolysis is one of various causes of rhabdomyolysis but has been rarely documented in the pediatric population. In general it is always important to exclude an underlying metabolic pathology. Complications of rhabdomyolysis can be many and severe: renal failure, cardiac arrhythmias, compartment syndrome, disseminated intravascular coagulation, lactic acidosis, etc.. Renal failure is the consequence of the acute tubular necrosis secondary to the obstruction of the renal tubules by myoglobin, which can become fatal. We report our experience with three adolescents that after starting a program of physical training, developed intense pain and muscle oedema at the ultrasound scan of the muscles involved in the exercise. Complementary studies excluded an underlying metabolic disease in all of them. The opportune treatment included symptomatic treatment and endovenous hydratation. Fortunately, none of them developed renal failure.

Relato de caso de rabdomiólise em um praticante de esportes radicais rapel e trekking, uma emergência a ser reconhecida / A case report of rhabdomyolysis in a practitioner of sports climbing and trekking, an emergency to be recognized

Rabdomiólise é uma síndrome que afeta os músculos estriados, de curso altamente variável e que pode ser de difícil diagnóstico, requerendo um elevado grau de suspeição. A realização de uma anamnese minuciosa e o reconhecimento do contexto sociocultural do paciente podem ser fundamentais. Seu manejo consiste principalmente no diagnóstico precoce e na prevenção de suas complicações, potencialmente fatais. Este artigo apresenta um caso raro de rabdomiólise em um praticante de rapel e trekking, primeiramente, por isquemia e lesão direta, agravada em sua evolução por atividade física extenuante. É apresentada uma breve revisão sobre a fisiopatologia, as manifestações, o diagnóstico laboratorial e o tratamento da rabdomiólise por esforço e suas complicações.

Rhabdomyolysis is a syndrome which affects skeletal muscles, of variable course and whose diagnosis workup can be difficult, requiring a high grade of suspicion. A detailed anamnesis and sociocultural patient profile recognition may be fundamental. The management relies essentially on its early diagnosis and prevention of potentially harmful complications. This article describes an rare case of rhabdomyolysis in a practitioner of rappel and trekking, primarily, due to ischemia and direct injury, aggravated on its evolution by strenuous exercise. A brief review about exertional rhabdomyolysis pathophysiology, clinical manifestations, laboratory diagnosis, treatment and complications is presented.

Rabdomiolisis y falla renal aguda en un paciente con trastorno depresivo recurrente tratado con escitalopram y quetiapina: Case Report / Rhabdomyolysis and Acute Renal Failure in a Recurrent Depressive Patient Treated with Escitalopram and Quetiapine

Objetivo: Describir un caso de rabdomiolisis y falla renal aguda asociado a la administración de quetiapina y escitalopram en un adulto joven en tratamiento por depresión recurrente. Métodos Descripción detallada del paciente y de su enfermedad actual, y revisión no sistemática de la literatura relevante. Resultados: Sujeto de 35 años con antecedentes de trastorno depresivo para el cual recibía escitalopram y quetiapina; presenta síntomas consistentes con rabdomiolisis y falla renal aguda luego de ingerir una sobredosis (900 mg) de quetiapina. La quetiapina y otros antipsicóticos han sido asociados a rabdomiolisis con o sin falla renal aguda. Igualmente, antidepresivos han sido asociados con episodios similares. El mecanismo que media tal asociación no ha sido encontrado. Conclusiones: Los antipsicóticos y los antidepresivos están asociados a rabdomiolisis en individuos con susceptibilidad biológica. Los efectos tóxicos de la serotonina pueden estar involucrados en tal asociación. Lo anterior obliga a su empleo cuidadoso en pacientes en riesgo de hiperfunción serotoninérgica.

Objective: To describe a case of quetipiane- and escitalopram-associated rhabdomyolysis and secondary acute renal failure in a young adult suffering from recurrent depression. Methods: detailed clinical description of the subject's case and relevant literature was reviewed. Results: A 35-year old male suffering from recurrent mayor depression treated with quetiapine and escitalopram, developed rhabdomyolysis and acute renal failure after ingesting an overdose of quetiapine (900 mg). Quetiapine and other antipsychotics have been related with rhabdomyolysis with or without renal failure in association or not with neuroleptic malignant syndromes. Similarly, antidepressant medications, specially venlafaxine but not escitalopram, have been associated with rhabdomyolysis. However, the exact mechanisms involved in this association have are not clear. Conclusions: Antipsychotic and antidepressant medications have been associated with rhabdomyolysis in vulnerable subjects. Serotonin-mediated toxicity has been proposed as a plausible etiological factor in these cases. Thus, psychotropic medications involving this neurotransmitter should be used cautiously in subjects at risk for serotonin hyperactivity.

Rhabdomyolysis Associated with Viral Encephalitis / 实用儿科临床杂志

Viral encephalitis is infectious diseases caused by many kinds virus which infects the brain and produces a series of clinical manifestations,it is an common disease in children.Rhabdomyolysis is a sort of syndrome characterized by striated muscle necrosis and the release of intracellular muscle constituents into the circulation,most notably high level of creatine phosphokinase and myoglobin,and myoglobi-nuria,which is often complicated with acute renal failure.It was reported that rhabdomyolysis could be associated with many viral encephalidities,the clinician should pay attention to this condition because it was not rare especially,when hematuria appearred in the course of viral encephalidities,serum creatine phosphate kinase,serum and urine myohemoglobin should be detected to identify whether rhabdomyolysis was existed.Once the diagnosis was confirmed,it should be treated with fluid administration and basification in order to avoid acute renal failure,and to improve prognosis on these patients.This study reviewed the literature on viral encephalidities and rhabdomyolysis.

Rhabdomyolysis in Indonesian marathon athlete.

Serum and urine myoglobin assessments were conducted on 37 national marathon athletes who participated in the Asian Marathon III & Proklamaton XV. Three athletes showed a myoglobin value of < 50 ug/L and the other 34 athletes showed a myoglobin value of 211-3300 ug/L. Rhabdomyolysis were only found in 2 athletes, thus the prevalence of rhabdomyolysis is 6.1%. A correlation was found between myoglobinemia value and the athlete’s performance.

A case of myoglobinuric acute renal failure due to polymyositis in patient with chronic hepatitis C / 대한내과학회지

A 73-year-old woman with chronic hepatitis C was hospitalized with proximal muscle weakness and generalized muscle pain. The patient was diagnosed as rhabdomyolysis with myoglobinuric acute renal failure. But there was no history of muscle compression, ingestion of drugs which can cause rhabdomyolysis, or alcohol abuse. The initial clinical features and laboratory findings showed no evidence of infectious myopathy or electrolyte abnormality. The electromyography and muscle biopsy was performed and polymyositis was diagnosed. Polymyositis, an idiopathic inflammatory myopathy, can cause rhabdomyolysis, but myoglobinuric acute renal failure due to polymyositis is very rare. We report a case of myoglobinuric acute renal failure caused by polymyositis with review of the literatures.

Exogenous causes of myoglobinuria: review of 26 cases

In this article, I review various causes of exogenous myoglobinuria(MU) and its pathogenesis in 26 consecutive patients admitted to emergency room, Asan Medical Center and determine whether there is a relationship between concentration of urine myoglobin(Mb) and acute renal failure(ARF) as a complication of MU. Serum and urine Mb were measured by RIA using myoglobin kit (Daiichi, Inc., Tokyo, Japan). The most common disorder of MU was septic shock with hypotension, followed by crush syndrome, major arterial occlusion by thormbosis, alcohol intoxication with status epilepticus, intoxication of unidentified snake venom and drug ingestion. On the basis of this limited amount of data, there is a significant association between high concentration in urine Mb(> 300 ng/ml) and ARF(Fisher's exact test, p< 0.005). To minimize the chances of development of ARF, routine urine Mb levels should be checked on patients at risk, especially septic shock with hypotension.

Management of myonephropathic-metabolic syndrome after acute arterial occlusion: report of 17 cases / 中国普通外科杂志

ObjectiveTo investigate the management of myonephropathic-metabolic syndrome (MNMS) after acute arterial occlusion. Methods17 cases of MNMS caused by acute arterial occlusion were restrospectively reviewed. Results5 cases were cured, 6 cases died of sudden cardiac arrest induced by hyperkalemia, and another 6 cases died of multiple organ dysfunction syndrome (MODS) complicated by acute renal failure. The total mortality rate was 71% and the amputation rate was 41%.ConclusionEarly revascularization should be performed in acute arterial occlusion. In patients with compartment syndrome, fasciotomy should be performed as soon as possible. Early amputation of gangrene limb is very important to prevent MNMS. Early and effective fluid resuscitation and alkalinization is the key point to prevent ARF, early hemodialysis for ARF is very important in treating MNMS.

Myoglobinuria Following General Anesthesia / 대한마취과학회지

The authors experienced a case of myoglobinuria accompanied by generalized myalgia and mild fever that developed 3 hours 30 minutes after general anesthesia. Tracheal intubation was done smoothly 5 minutes after injection of thiopental sodium(275 mg) and pancuronium bromide(6 mg), and anesthesia was maintained with ethrane/N2O/O2(1.5-2%/21/21/min). There was no specific event except tachycardia and fluctuation of blood pressure throughout operation. In this case, we assume that the myoglobinuria is a presentation of the sign of an abortive type of malignant hyperthermia. However, it was not confirmed. We had good patient outeome with the supportive measures of hydration and diuresis. The patient was discharged twenty three days after operation without any complication.

An Ultrastructural Study of Renal Tissues with Experimenta Crush Syndrome in Rabbits / 第三军医大学学报

Experimental crush syndrome was inflicted to the kidneys of rabbits and specimens of renal tissues were studied with electron microscope. It was found that apart from the damage to the renal tubules, the ultrastructural alterations of the glomeruli were also prominent and were characterized as follows:(1) Hypertrophy and hyperplasia of the glomerular cells resulting in narrowing and/or obliteration of the capillary loops.(2) Retrogressive changes of the glomerular cells in varying degrees such as mitochondrial swelling, dilatation of ER, vacuole formation, etc.On the basis of the morphological findings of the renal tissues in association with the clinical manifestations of acute renal failure (ARF), it is proposed that in addition to the damage of the renal tubules, a reduction of the glomerular filtration rate, which is the result of the altered hemodynamics in the renal vessels and the ultrastructural changes of the glomerular cells also play an important role in the pathogenesis of ARF.