Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 14203, USA.
Division of Geriatrics and Palliative Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 14215, USA.
J Med Case Rep. 2023 Jul 10;17(1):287. doi: 10.1186/s13256-023-04018-5.
Rhabdomyolysis-induced acute kidney injury is a serious condition that can progress to acute renal failure if not promptly identified and treated. Rhabdomyolysis occurs when serum creatine kinase levels approach > 1000 U/L (five times the normal upper limit). The chance of acute kidney injury increases as the levels of creatine kinase increase. Although Huntington's disease is associated with muscle atrophy, elevated baseline creatine kinase levels in these patients have not been routinely reported.
A 31-year-old African American patient presented to the emergency department after he was found unconscious from a fall attributed to the progression of his Huntington's disease. On admission, he had an extremely high creatine kinase level of 114,400 U/L and was treated with fluids, electrolyte balance, and dialysis. However, his condition progressed to acute renal failure and he later developed posterior reversible encephalopathy syndrome, requiring transfer to the intensive care unit with placement on continuous renal replacement therapy. Eventually, his kidney function recovered and he was discharged home with 24/7 care by his family for persistent impairments related to his Huntington's disease.
This case report underscores the importance of promptly recognizing elevated creatine kinase levels in patients with Huntington's disease due to the risk of developing rhabdomyolysis-induced acute kidney injury. If not aggressively treated, the condition of these patients is likely to progress to renal failure. Anticipating the progression of rhabdomyolysis-induced acute kidney injury is paramount to improving clinical outcomes. Additionally, this case identifies a potential link between the patient's Huntington's disease and his abnormally elevated creatine kinase, a finding not described in the literature of rhabdomyolysis-induced kidney injuries to date and an important consideration for future patients with similar comorbidities.
横纹肌溶解症引起的急性肾损伤是一种严重的疾病，如果不能及时识别和治疗，可能会发展为急性肾衰竭。当血清肌酸激酶水平接近>1000 U/L（正常值上限的五倍）时，就会发生横纹肌溶解症。肌酸激酶水平升高，急性肾损伤的风险增加。尽管亨廷顿病与肌肉萎缩有关，但这些患者的基线肌酸激酶水平升高尚未得到常规报告。
一名 31 岁的非裔美国患者因亨廷顿病的进展而摔倒导致昏迷，被送往急诊室。入院时，他的肌酸激酶水平极高，为 114400 U/L，接受了液体、电解质平衡和透析治疗。然而，他的病情进展为急性肾衰竭，后来发展为后部可逆性脑病综合征，需要转入重症监护病房，接受连续肾脏替代治疗。最终，他的肾功能恢复，因亨廷顿病持续存在的损害，他在家中接受 24/7 的家庭护理。
本病例报告强调了及时识别亨廷顿病患者肌酸激酶水平升高的重要性，因为这会增加发生横纹肌溶解症引起的急性肾损伤的风险。如果不积极治疗，这些患者的病情很可能会进展为肾衰竭。预测横纹肌溶解症引起的急性肾损伤的进展对于改善临床结局至关重要。此外，本病例还发现了患者亨廷顿病与其异常升高的肌酸激酶之间的潜在联系，这一发现目前在横纹肌溶解症引起的肾损伤文献中并未描述，这也是未来患有类似合并症的患者需要考虑的重要因素。
