Department of Intensive Care, Erasmus Medical Centre, University Medical Center, Rotterdam, The Netherlands,
Department of Intensive Care, Erasmus Medical Centre, University Medical Center, Rotterdam, The Netherlands.
Blood Purif. 2020;49(6):743-747. doi: 10.1159/000505899. Epub 2020 Feb 28.
Rhabdomyolysis, if severe, can lead to acute kidney injury (AKI). Myoglobin is an iron and oxygen-binding protein that is freely filtered by the glomerulus. Precipitation of myoglobin in the nephrons' distal parts is responsible for tubular damage with AKI as a consequence. Extracorporeal clearance of myoglobin is conventionally attempted by the use of continuous renal replacement therapy (CRRT) with high cut-off dialysis membranes to limit the extent of the damage. We describe a case of a 56-year-old man with traumatic crush injury and a persistent source of muscle ischaemia unresponsive to high dose CRRT with EMiC-2 filter. Due to therapy failure, he was subsequently treated with the addition of a haemoadsorber (CytoSorb®) to the circuit. This reduced myoglobin and creatine kinase levels successfully despite ongoing tissue ischaemia. However, CytoSorb® was not enough to maintain microcirculatory perfusion, resulting in the eventual demise of the patient due to severity of the injury. Our report indicates that myoglobin was efficiently removed with CytoSorb® following exchange with the conventional high cut-off filter in continuous venovenous haemodialysis in severe traumatic rhabdomyolysis.
横纹肌溶解症如果严重，可导致急性肾损伤 (AKI)。肌红蛋白是一种含铁和氧的蛋白质，可自由地被肾小球过滤。肌红蛋白在肾单位远端的沉淀导致肾小管损伤，从而导致 AKI。传统上，通过使用高通量透析膜的连续肾脏替代治疗 (CRRT) 来清除肌红蛋白，以限制损伤的程度。我们描述了一例 56 岁男性，因创伤性挤压伤导致持续的肌肉缺血，对高剂量 CRRT 联合 EMiC-2 过滤器治疗无反应。由于治疗失败，随后在回路中添加了血液吸附剂 (CytoSorb®)。尽管持续存在组织缺血，但这成功降低了肌红蛋白和肌酸激酶水平。然而，CytoSorb® 不足以维持微循环灌注，最终由于损伤的严重程度导致患者死亡。我们的报告表明，在严重创伤性横纹肌溶解症的连续静脉-静脉血液透析中，与传统的高通量过滤器进行交换后，CytoSorb® 可有效地清除肌红蛋白。
