Forcellini Silvia, Fabbian Fabio, Battaglia Yuri, Storari Alda
G Ital Nefrol. 2014 Nov-Dec;31(6).
Rhabdomyolysis is characterized by skeletal muscle necrosis resulting in release of large amounts of toxic muscle cell components, including electrolytes, myoglobin, and other sarcoplasmic proteins into circulation. Creatinine phosphokinase (CPK) and myoglobin serum levels constitute the diagnostic hallmark. Nowadays, drugs have become one of the most frequent cause of rhabdomyolysis and acute kidney injury (AKI) is a potential life-threatening complication. The mechanisms involved in the development of AKI in rhabdomyolysis are intrarenal vasoconstriction, direct and ischemic tubule injury and tubular obstruction. According to some clinical series, the mortality rate in patients who develop AKI due to rhabdomyolysis is highly variable. The cornerstone in managing this condition is the early, aggressive repletion of fluids. The composition of replacement fluid remains controversial. Saline and sodium bicarbonate, especially in patients with metabolic acidosis, seem to be a reasonable approach. When AKI produces refractory hyperkalemia, acidosis or volume overload, renal replacement therapy is indicated.
横纹肌溶解症的特征是骨骼肌坏死，导致大量有毒的肌肉细胞成分释放到循环系统中，这些成分包括电解质、肌红蛋白和其他肌浆蛋白。肌酸磷酸激酶（CPK）和肌红蛋白血清水平是诊断的标志。如今，药物已成为横纹肌溶解症最常见的病因之一，而急性肾损伤（AKI）是一种潜在的危及生命的并发症。横纹肌溶解症中急性肾损伤发生发展的机制包括肾内血管收缩、直接和缺血性肾小管损伤以及肾小管阻塞。根据一些临床系列报道，因横纹肌溶解症导致急性肾损伤患者的死亡率差异很大。治疗这种疾病的关键是早期积极补液。补液的成分仍存在争议。生理盐水和碳酸氢钠，尤其是对于代谢性酸中毒患者，似乎是一种合理的方法。当急性肾损伤导致难治性高钾血症、酸中毒或容量超负荷时，需要进行肾脏替代治疗。
