Lim Young Shin, Cho Heeyeon, Lee Sang Taek, Lee Yeonhee
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Pediatrics, Gyeongsang National University Changwon Hospital, Changwon, Korea.
Korean J Pediatr. 2018 Mar;61(3):95-100. doi: 10.3345/kjp.2018.61.3.95. Epub 2018 Mar 19.
This study aimed to evaluate the clinical findings in pediatric rhabdomyolysis and the predictive factors for acute kidney injury (AKI) in Korean children.
Medical records of 39 Korean children, who were newly diagnosed with rhabdomyolysis from January 2008 to December 2015, were retrospectively analyzed. The diagnosis was made from the medical history, elevated serum creatinine kinase level >1,000 IU/L, and plasma myoglobin level >150 ng/mL. Patients with muscular dystrophy and myocardial infarction were excluded.
The median patient age at diagnosis was 14.0 years (range, 3-18 years), and the male to female ratio was 2.5. The most common presenting symptom was myalgia (n=25, 64.1%), and 14 patients (35.9%) had rhabdomyolysis-induced AKI. Eighteen patients (46.2%) had underlying diseases, such as epilepsy and psychotic disorders. Ten of these patients showed rhabdomyolysis-induced AKI. The common causes of rhabdomyolysis were infection (n=12, 30.7%), exercise (n=9, 23.1%), and trauma (n=8, 20.5%). There was no difference in the distribution of etiology between AKI and non-AKI groups. Five patients in the AKI group showed complete recovery of renal function after stopping renal replacement therapy. The median length of hospitalization was 7.0 days, and no mortality was reported. Compared with the non-AKI group, the AKI group showed higher levels of peak creatinine kinase and myoglobin, without statistical significance.
The clinical characteristics of pediatric rhabdomyolysis differ from those observed in adult patients. Children with underlying diseases are more vulnerable to rhabdomyolysis-induced AKI. AKI more likely develops in the presence of a high degree of albuminuria.
本研究旨在评估韩国儿童横纹肌溶解症的临床特征以及急性肾损伤（AKI）的预测因素。
回顾性分析2008年1月至2015年12月期间新诊断为横纹肌溶解症的39例韩国儿童的病历。根据病史、血清肌酐激酶水平>1000 IU/L以及血浆肌红蛋白水平>150 ng/mL做出诊断。排除患有肌肉萎缩症和心肌梗死的患者。
诊断时患者的中位年龄为14.0岁（范围3 - 18岁），男女比例为2.5。最常见的症状是肌痛（n = 25，64.1%），14例患者（35.9%）发生横纹肌溶解症诱发的急性肾损伤。18例患者（46.2%）患有潜在疾病，如癫痫和精神障碍。其中10例患者发生横纹肌溶解症诱发的急性肾损伤。横纹肌溶解症的常见病因是感染（n = 12，30.7%）、运动（n = 9，23.1%）和创伤（n = 8，20.5%）。急性肾损伤组和非急性肾损伤组之间病因分布无差异。急性肾损伤组中有5例患者在停止肾脏替代治疗后肾功能完全恢复。中位住院时间为7.0天，无死亡报告。与非急性肾损伤组相比，急性肾损伤组的肌酐激酶和肌红蛋白峰值水平较高，但无统计学意义。
儿童横纹肌溶解症的临床特征与成人患者不同。患有潜在疾病的儿童更容易发生横纹肌溶解症诱发的急性肾损伤。在存在高度蛋白尿的情况下，急性肾损伤更易发生。
