Images in Clinical Medicine
Acute Myoglobinuric Renal Failure
N Engl J Med 2001; 345:1747December 13, 2001
- Article
Figure 1 A 26-year-old man had sudden fever and chills with severe muscle pain and weakness in his legs and pectoral muscles while mountaineering in the Andes. He was brought to a local hospital, where he received hemodialysis three times because of anuria and a rapid rise in the serum creatinine level before being transferred to our unit. The following laboratory values were recorded on admission to our unit: creatinine, 10.5 mg per deciliter (928 μmol per liter); blood urea nitrogen, 85 mg per deciliter (30.3 mmol per liter); creatine kinase, 1990 U per liter; calcium, 8.16 mg per deciliter (2.04 mmol per liter); phosphorus, 6.19 mg per deciliter (2.0 mmol per liter); serum myoglobin, 283 μg per liter; and white-cell count, 14.5×103 per cubic millimeter. Urine dipstick analysis was positive (+++) for protein and red cells. Analysis of urinary sediment (Panel A; ×400) showed multiple pigmented casts, leukocyturia, and hematuria without dysmorphic red cells. Renal biopsy showed intratubular reddish-brownish, granular casts. Tubuli were slightly dilated, the tubular epithelium was flattened, and the glomeruli appeared normal. Intratubular casts were positive for myoglobin on immunoperoxidase staining (Panel B; ×400) with an antibody against human myoglobin, confirming the diagnosis of acute myoglobinuric renal failure. Possible causes of the rhabdomyolysis were physical strain at high altitude and the consumption of coca leaves and coca tea to prevent mountain sickness. No infectious cause could be identified. The patient had anuria or oliguria for 10 days. He received a total of seven sessions of hemodiafiltration, until urine flow returned and the serum creatinine levels began to fall. At the time of discharge, he had a serum creatinine level of 1.0 mg per deciliter (88.4 μmol per liter).
Harald D. Rupprecht, M.D.
Ludwig Maximilians University, 80336 Munich, GermanyRegine Riess, M.D.
Klinikum Nürnberg, 90340 Nuremberg, Germany- Citing Articles (1)
Citing Articles
1
Jenny O'Baugh, Lesley M. Wilkes, Suzanne Luke, Ajesh George. (2003) 'Being positive': perceptions of patients with cancer and their nurses. Journal of Advanced Nursing 44:3, 262-270
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