Continuous renal replacement therapy for rhabdomyolysis-induced acute renal failure following trauma / 中华创伤杂志

Objective To improve diagnose and therapy of post-traumatic acute renal failure induced by rhabdomyolysis. Methods A total of 20 patients with post-traumatic acute renal failure induced by rhabdomyolysis were analyzed retrospectively in aspects of clinical manifestation, laboratory examination and treatment. Of all, there were 9 patients treated with continuous renal replacement therapy (CRRT), while the other 11 were set as control, receiving no CRRT. Results After treatment with CRRT, 7 patients obtained clinical curing, with 2 deaths. As for control patients, there were 5 patients with secondary chronic renal insufficiency, 1 with clinical curing and 5 deaths. Conclusions Early diagnosis, CRRT, sufficient hydration, hematedialysis and supportive treatment are key points to improve the cure rate. It is important to apply CRRT for patients with renal inadequacy.

Clinical research on the secondary fulminant multiple organ dysfunction syndrome caused by rhabdomylysis / 解放军医学杂志

Objective To analyze the causes of rhabdomylysis (RM), pathogenetic mechanisms and possible effective interventions for secondary multiple organ dysfunction syndrome (MODS) caused by RM. Methods causes of RM, clinical manifestations, severity of disease evaluated by APACHE Ⅱ and Marshall MODS Score, results of laboratory, clinical interventions and outcome were analyzed in all three MODS cases secondary to RM. Results The specific causes of RM were not clear. However, persistent acute twitch and hyperthermia occurred very early in all three cases. Plasma CK was increased 50 fold over the normal level. Number of injured organs was 7, 4 and 6, respectively. Marshall MODS score ranged from 15 to 21. APACHE Ⅱ scores were greater than 20 in all cases. One patients survived, the other two died. CRRT started early had been shown to be beneficial to decrease the markedly elevated plasma CK, CK-Mb, ALT, ALT and LDH. Conclusion Although the mechanism of RM with secondary MODS has not been elucidated yet, deep sedation as well as effective hypothermia to control acute twitch and hyperthermia should be the essential interventions to attenuate further organ injury. Additionally, based on effective advanced life support, CRRT started early could be an important therapy for MODS secondary to RM.