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Fast recovery of myoglobinuric acute renal failure treated with continuous venovenous hemodiafiltration

Palle Toft

CaseRepClinPractRev 2003; 4(1):4-7

ID: 429003

Background: Trauma patients are at risk of developing acute renal failure (ARF) due to rhabdomyolysis. ARF is usually caused by a combination of myoglobulinuria, hypotension, hypovolemia and acidosis. If ARF develops, myoglobin can be cleared by ultrafiltration used in continuous venovenous hemodiafiltration (CVVHDF) but not by hemodialysis (HD).Case Report: A 41-year-old man developed rhabdomyolysis after a motorcycle accident with otherwise minor tissue injury and without any respiratory and hemodynamic problems. Plasma myoglobin and creatine kinase (CK) were not measured at admission to hospital. The patient received 6.5 of fluid within 24 hours after admission and laboratory signs of hemoconcentration were observed. Twenty four hours after admission, plasma myoglobin and CK were 134,309 Kg l-1 and 134I,349 Iu-l, respectively, and ARF developed. After 10 days of CVVHDF treatment plasma myoglobin had CK had nearly normalized and after 15 days renal function was recovered.Conclusions: Plasma myoglobin and CK should be measured early in trauma patients. In cases with increased levels, aggressive infusion of intravenous fluids and alkalization of the urine should be initiated to prevent ARF. In the reported case, myoglobin was removed effectively by using CVVHDF in a patient with ARF due to severe rhabdomyolysis.

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