Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA, USA.
Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA.
Am J Case Rep. 2020 May 20;21:e924347. doi: 10.12659/AJCR.924347.
BACKGROUND Elevation of creatine kinase (CK) activity has been shown to be predictive of acute kidney injury (AKI) in rhabdomyolysis. Patients with extremely high CK activity with preserved renal function are uncommon. This report describes a case of non-traumatic rhabdomyolysis, with a markedly elevated CK activity, without associated AKI. CASE REPORT A 22-year-old male presented with severe generalized myalgias and darkened urine for 1 week prior to his admission. The patient presented to the Emergency Department with initial CK activity of >40 000 U/L and a serum creatinine level of 0.77 mg/dL. Urinalysis was positive for myoglobinuria. Serum cystatin C confirmed an estimated glomerular filtration rate of 144 mL/min/1.73 m². Several causes of rhabdomyolysis, including viral infections, Lyme disease, viral hepatitis, hypothyroidism, and cocaine abuse were investigated; however, all were negative. He was given a bolus of 2 liters of normal saline and continued on intravenous normal saline at 250 mL/hour throughout his hospital stay. Urine output remained adequate. We were able to quantify his serum CK activity by dilution method, which revealed a serum CK activity of >150 000 U/L. His CK levels consistently trended down with treatment. CONCLUSIONS An extremely high CK activity in rhabdomyolysis may lead to AKI. However, preserved kidney function is possible. Young age, no concurrent cocaine use, and adequate oral fluid hydration may prevent AKI in rhabdomyolysis. Physicians need to remain vigilant for cases of rhabdomyolysis that have not yet caused renal compromise.
肌酸激酶（CK）活性升高已被证明可预测横纹肌溶解症中的急性肾损伤（AKI）。CK 活性极高但肾功能正常的患者并不常见。本报告描述了一例非外伤性横纹肌溶解症，CK 活性显著升高，但无相关 AKI。
一名 22 岁男性因严重全身肌痛和尿液变黑 1 周前来就诊。患者因初始 CK 活性>40000 U/L 和血清肌酐水平 0.77 mg/dL 而就诊于急诊部。尿分析显示肌红蛋白尿阳性。血清胱抑素 C 证实估算肾小球滤过率为 144 mL/min/1.73 m²。研究了包括病毒感染、莱姆病、病毒性肝炎、甲状腺功能减退和可卡因滥用在内的多种横纹肌溶解症的病因，但均为阴性。患者接受了 2 升生理盐水的推注，并在整个住院期间以 250 mL/h 的速度持续输注静脉生理盐水。尿量充足。我们通过稀释法能够定量其血清 CK 活性，结果显示血清 CK 活性>150000 U/L。他的 CK 水平随着治疗而持续下降。
横纹肌溶解症中极高的 CK 活性可能导致 AKI。然而，肾功能可能正常。年轻、无同时使用可卡因以及充足的口服液体水化可能可预防横纹肌溶解症引起的 AKI。医生需要对尚未导致肾损伤的横纹肌溶解症保持警惕。
