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Erschienen in:
09.11.2017 | Clinical Quiz
Rhabdomyolysis-associated acute kidney injury: Questions
Erschienen in: Pediatric Nephrology | Ausgabe 9/2018
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A 17-year-old boy was admitted with complaints of diarrhea, vomiting and decreased urinary output. Diarrhea continued for 1 week and occurred five to six times a day. The stool was green and did not contain blood or mucus. Vomiting and oliguria started 2 days before his presentation to our medical institution. He described widespread muscle pain and weakness. There was no accompanying hematuria and weight gain. A detailed history revealed that he had swum in the stream nearby his house 2 weeks before any of the complaints appeared. There was no consanguinity between his parents. On physical examination his height was 170 cm (10–25 percentile), weight was 58 kg (3–10 percentile), heart rate was 96 bpm, and blood pressure was 115/85 mmHg (95th percentile 132/85 mmHg). A diffuse edema on the eyelids and lower extremities, icterus on the sclera and hepatomegaly (liver palpable 2 cm below the costal margin) were detected. Systemic examination did not reveal any additional pathologies. Some of the laboratory values are shown in Table 1. The results of the laboratory examinations and blood smears did not support hemolysis. Urinalysis revealed a urine pH of 5.5, density of 1011, glucose 1+, protein 1+, hemoglobin 3+; microscopic examination revealed 49 leukocytes/high-power field (HPF) and 211 erythrocyte/HPF.
Table 1
Laboratory results of the patient's application
|
Laboratory parameters
|
Value
|
Reference range
|
|---|---|---|
|
Hemoglobin (g/dL)
|
12.2
|
11–14
|
|
Leukocyte (count/mm3)
|
13,250
|
4,500–10,300
|
|
Thrombocyte (count/mm3)
|
32,000
|
156,000–373,000
|
|
C-reactive protein (mg/dL)
|
18.9
|
< 0.5
|
|
Procalcitonin (ng/mL)
|
10.8
|
< 0.1
|
|
Blood urea nitrogen (mg/dL)
|
23
|
8–20
|
|
Serum creatinine (mg/dL)
|
3.3
|
0.5–1.2
|
|
Alanine aminotransferase (U/L)
|
29
|
< 40
|
|
Aspartate aminotransferase (U/L)
|
169
|
< 40
|
|
Gamma glutamyltransferase (U/L)
|
57
|
< 38
|
|
Lactate dehydrogenase (U/L)
|
300
|
110–295
|
|
Reticulocyte count (%)
|
0.67
|
0.5–1.5
|
|
Haptoglobin (mg/dl)
|
236
|
30–200
|
|
Total bilirubin (mg/dl)
|
5.4
|
0.3–1.2
|
|
Direct bilirubin (mg/dl)
|
4.9
|
< 0.3
|
|
Serum creatine kinase (U/L)
|
7748
|
33–211
|
|
Serum myoglobin (ng/ml)
|
1618
|
< 110
|
|
Estimated glomerular filtration rate ( mL/m2/min)a
|
28.3
|
> 120
|