Takahashi Tetsuya
Critical Care and Emergency Medical Center, Yokohama-City Minato Red Cross Hospital.
Kansenshogaku Zasshi. 2011 May;85(3):268-71. doi: 10.11150/kansenshogakuzasshi.85.268.
Subjects with primary human immunodeficiency virus (HIV) infection often have acute retroviral syndrome. Some develop rhabdomyolysis, which can lead to acute renal failure. A 21-year-old man admitted for consciousness disturbance was initially considered to have aseptic meningitis associated with primary HIV infection. On hospitalization day 3, he developed severe rhabdomyolysis with elevated serum creatine kinase (CK) of 218,100 IU/L with serum creatinine normal at 0.9 mg/dL. Following massive extracellular fluid infusion and urinary alkalinization, serum CK decreased smoothly, without renal failure. Severe rhabdomyolysis was concomitant with systemic inflammatory response syndrome (SIRS) only on admission day. Acute renal failure in those with rhabdomyolysis may be influenced by renal possibly due to SIRS and tubular damage from reactive oxygen species, rather than by tubular obstruction by myoglobin casts, although this depends on the extent of myolysis. Acute renal failure is prevented in those with primary HIV infection developing rhabdomyolysis, based on renal blood flow control, if condition causing SIRS do not become a complication.
原发性人类免疫缺陷病毒（HIV）感染患者常出现急性逆转录病毒综合征。部分患者会发生横纹肌溶解，进而可能导致急性肾衰竭。一名因意识障碍入院的21岁男性最初被认为患有与原发性HIV感染相关的无菌性脑膜炎。住院第3天，他出现严重横纹肌溶解，血清肌酸激酶（CK）升高至218,100 IU/L，而血清肌酐正常，为0.9 mg/dL。在大量输注细胞外液并进行尿液碱化后，血清CK平稳下降，未出现肾衰竭。仅在入院当天，严重横纹肌溶解与全身炎症反应综合征（SIRS）同时存在。横纹肌溶解患者发生的急性肾衰竭可能受肾脏因素影响，这可能是由于SIRS以及活性氧对肾小管的损伤，而非肌红蛋白管型导致的肾小管梗阻，不过这取决于肌溶解的程度。对于原发性HIV感染并发横纹肌溶解的患者，如果导致SIRS的情况未成为并发症，基于肾血流控制可预防急性肾衰竭。
