Smoszna J, Pietrzak B, Wańkowicz Z
Z Kliniki Nefrologii ze Stacja Dializ Centralnego Szpitala Klinicznego WAM w Warszawie.
Pol Merkur Lekarski. 2000 Dec;9(54):826-9.
Eleven cases (5 F + 6 M; mean age 48.0 years) of acute noninflammatory renal failure (ANRF) in the course of rhabdomyolysis (RBM) were treated with hemodialysis in years 1995-1999. The causes of RBM were the following: ischemia of lower limbs after vascular operations (4 cases), exhausting exercise with rapid body cooling (3 cases), multiorgan failure after traffic accident, acute myositis (1 case), status epilepticus (1 case), rapid clinical course of viral infection (1 case). It was necessary to perform from 1 to 13 hemodialyses in every patient. In nine cases, complete normalization of renal function during 5 to 30 days of therapy was achieved. Two patients died due to multiorgan complications after vascular operations despite effective dialysis therapy. The following correlation were found: positive between initial values of creatine phosphokinase (CPK) activity and creatinine and uric acid concentrations in the blood and negative correlation between CPK and serum calcium concentrations. The higher initial values of CPK activity were observed the more hemodialysis procedures were necessary and the longer time was needed to normalize renal function. On the base of initial, limited up to now, own results it seems that hemodialysis in ANRF in the course of RBM should be started immediately in cases with high activity of CPK in the blood (above 10,000 U/L).
1995年至1999年期间,对11例横纹肌溶解症(RBM)并发急性非炎性肾衰竭(ANRF)的患者(5例女性+6例男性;平均年龄48.0岁)进行了血液透析治疗。RBM的病因如下:血管手术后下肢缺血(4例)、剧烈运动后身体快速降温(3例)、交通事故后多器官功能衰竭、急性肌炎(1例)、癫痫持续状态(1例)、病毒感染临床过程进展迅速(1例)。每位患者需要进行1至13次血液透析。9例患者在治疗5至30天内肾功能完全恢复正常。2例患者尽管接受了有效的透析治疗,但仍因血管手术后多器官并发症死亡。发现以下相关性:血液中肌酸磷酸激酶(CPK)活性的初始值与肌酐和尿酸浓度呈正相关,CPK与血清钙浓度呈负相关。CPK活性的初始值越高,所需的血液透析次数越多,肾功能恢复正常所需的时间越长。根据目前有限的自身研究结果,对于血液中CPK活性高(高于10,000 U/L)的RBM并发ANRF患者,似乎应立即开始血液透析。