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3 out of 5

Non oliguric renal failure is seen in? (LQ)

A Diabetes

C Multiple myeloma
D Rhabdomyolysis

Ans. D Rhabdomyolysis

This results from skeletal muscle breakdown, with release of its contents into the circulation including myoglobin. Potassium, phosphate, urate and creatinine kinase.

Complications include hyperkaliemia and ARF:

Causes of rhabdomyolysis :

1. i. Trauma. ii. Prolonged immobilization iii. burns, iv. crush injury v. excessive exercise vi. uncontrolled seizures;

2. Drugs and toxins: i. statins, ii. fibrates, iii. alcohol, iv. ecstasy, v. heroin, vi. snake bite, vii. carbon monoxide, viii. neuroleptic malignant syndrome ,

3. Infections: Coxsackie. EBV. influenza; myositis, Malignant hyperpyrexia

4. Inherited muscle disorders: McArdle’s disease. Duchenne’s muscular dystrophy.

Clinical features of rhabdomyolysis: Often of the cause, with muscle weakness of pain, swelling tenderness and red ­brown urine non oliguric renal failure.

Tests: Blood tests show a raised CK. Dark urine is +ve for blood on dipstick but without RBCs on microscopy.

Confirm­ed by +ve urinary /serum myoglobin.

Others: Hyperkalemia, Hyperphosphatemia, Hyperuricemia, Hypocalcemia. (AIPG 06)

ARF occurs 12-24 hours later and DIC is associated

Compartment syndrome can result from muscle injury.

Extra Edge: Treatment:

1. Urgent treatment for hyperkaliemia.

2. In dehydration fluid replacement is a priority to prevent ARF: maintain urine output at 300ml/h until myoglobinuria has stopped (initially up to 1.5 lit may be needed).

3. IV sodium bicarbonate is used to alkalinize urine to pH >6.5, to stabilize a less toxic form of myoglobin.

Dialysis may be needed, full renal recovery is usually there.