[Nontraumatic rhabdomyolysis: its etiology and the predictive factors of acute kidney failure].

BACKGROUND

The aim of this study was to determine the causes of non traumatic or medical rhabdomyolysis (RM) and analyze the clinical and biologic characteristics, as well as the predictive factors of acute renal failure (ARF).

METHODS

Fifty-nine patients with RM admitted to the Internal Medicine Department over an 18-month period were prospectively studied. The patients were classified into etiologic groups. Anamnesis, physical exploration and general analytical studies including creatinkinase, myoglobin, aldolase, magnesium and proteinogram were performed. Urine sodium was determined in patients with ARF>

RESULTS

Myalgias in 14 patients (23.7%) and a decrease in strength in 11 patients (18.6%) were the main clinical manifestations observed. As a sole cause, convulsion was the most frequent manifestation in 11 patients (18.6%) followed by muscular compression in 10 patients (16.9%). In the plurietiologic group the most frequent manifestation was muscular compression in 5 patients (16.9%) followed by alcoholism in 4 patients (6.7%). No differences were found in either the clinical manifestation or the biology of the RM among the different etiologies. Eight patients presented ARF (13.5%) with one patient requiring dialysis, and good response being observed with conservative treatment in 5 patients. On multivariant analysis the statistically significant ARF predictive factors were: age over 70 years (p = 0.003), nonketotic hyperosmolar diabetic coma (p = 0.01), previous dehydration (p = 0.001) and initial uric acid levels greater than or equal to 6 mg/dl (p = 0.002).

CONCLUSIONS

The clinical expression of rhabdomyolysis was small with the most frequent manifestations being convulsions and muscular compression. The predictive factors for acute renal failure were advanced age, nonketotic hyperosmolar diabetic coma, dehydration, and hyperuricemia.