Nakano Y, Simizu K, Ando M, Nakano S, Koyanagi R
Tokyo Rousai Hospital, Japan.
Nihon Jinzo Gakkai Shi. 1990 Nov;32(11):1221-7.
We experienced 5 cases of acute renal failure due to rhabdomyolysis during the last two years and investigated those etiologies. Diagnosis of rhabdomyolysis was established by the detection of elevated serum creatine phosphokinase, myoglobin, aldolase, myoglobinuria as well as by the clinical course. The respective underlying illness of the 5 cases were grand mal seizures, infection (high fever), heat stroke, diabetes mellitus with hyperosmolar nonketotic coma and cerebral infarction treated by barbiturate. In this investigation, however, any single cause was not enough as the etiologies of rhabdomyolysis. There were multiple factors responsible to rhabdomyolysis in each case, such as hypokalemia, hypophosphatemia, shock, arteriosclerosis, etc. Some cases could not be classified as traumatic or non-traumatic rhabdomyolysis. Thus, in one case, acute renal failure due to rhabdomyolysis induced by the combination of grand mal seizures and serum potassium/phosphate depletion. 2 cases recovered without hemodialysis. 3 cases died in multiple organ failure, included a case treated by hemodialysis. We conclude that acute renal failure due to rhabdomyolysis induced easily by numerous diseases and early diagnosis is recommended.
在过去两年中,我们遇到了5例因横纹肌溶解导致的急性肾衰竭病例,并对其病因进行了调查。横纹肌溶解的诊断通过检测血清肌酸磷酸激酶、肌红蛋白、醛缩酶升高以及肌红蛋白尿,并结合临床病程来确定。这5例患者各自的基础疾病分别为癫痫大发作、感染(高热)、中暑、伴有高渗性非酮症昏迷的糖尿病以及接受巴比妥类药物治疗的脑梗死。然而,在本次调查中,没有任何单一病因足以解释横纹肌溶解的发生。在每个病例中,都有多种因素导致横纹肌溶解,如低钾血症、低磷血症、休克、动脉硬化等。有些病例无法归类为创伤性或非创伤性横纹肌溶解。因此,在1例病例中,癫痫大发作与血清钾/磷酸盐耗竭共同导致了横纹肌溶解,进而引发急性肾衰竭。2例患者未进行血液透析即康复。3例患者死于多器官功能衰竭,其中1例接受了血液透析治疗。我们得出结论,多种疾病容易诱发横纹肌溶解导致急性肾衰竭,建议早期诊断。