Acute Kidney Injury in Rhabdomyolysis: A 5-Year Children’s Hospital Network Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population and Design
2.2. Definitions
- Myoglobinuria as patients with myoglobin in the urine and/or with urinalysis that was positive for blood but negative for red blood cells [16];
- AKI using Kidney Disease: Improving Global Outcomes (KDIGO) guidelines [17]. When baseline creatinine levels were unavailable, creatinine levels ≥ 0.3 mg/dL of the upper limit for age within 48 h of symptom onset were considered indicative of AKI;
- Maintenance fluid rate as calculated by the Holliday–Segar technique [18].
2.3. Inclusion Criteria
2.4. Exclusion Criteria
2.5. Statistical Methods
3. Results
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Giannoglou, G.D.; Chatzizisis, Y.S.; Misirli, G. The Syndrome of Rhabdomyolysis: Pathophysiology and Diagnosis. Eur. J. Intern. Med. 2007, 18, 90–100. [Google Scholar] [CrossRef] [PubMed]
- Szugye, H.S. Pediatric Rhabdomyolysis. Pediatr. Rev. 2020, 41, 265–275. [Google Scholar] [CrossRef] [PubMed]
- Chen, C.-Y.; Lin, Y.-R.; Zhao, L.-L.; Yang, W.-C.; Chang, Y.-J.; Wu, K.-H.; Wu, H.-P. Clinical Spectrum of Rhabdomyolysis Presented to Pediatric Emergency Department. BMC Pediatr. 2013, 13, 134. [Google Scholar] [CrossRef] [PubMed]
- Gardner, H.M.; Askenazi, D.J.; Hoefert, J.A.; Helton, A.; Wu, C.L. Acute Kidney Injury among Children Admitted with Viral Rhabdomyolysis. Hosp. Pediatr. 2021, 11, 878–885. [Google Scholar] [CrossRef] [PubMed]
- Mannix, R.; Tan, M.L.; Wright, R.; Baskin, M. Acute Pediatric Rhabdomyolysis: Causes and Rates of Renal Failure. Pediatrics 2006, 118, 2119–2125. [Google Scholar] [CrossRef]
- Elsayed, E.F.; Reilly, R.F. Rhabdomyolysis: A Review, with Emphasis on the Pediatric Population. Pediatr. Nephrol. 2010, 25, 7–18. [Google Scholar] [CrossRef]
- Chavez, L.O.; Leon, M.; Einav, S.; Varon, J. Beyond Muscle Destruction: A Systematic Review of Rhabdomyolysis for Clinical Practice. Crit. Care 2016, 20, 135. [Google Scholar] [CrossRef]
- Park, Y.; Song, J.Y.; Kim, S.Y.; Kim, S.H. Clinical Characteristics of Rhabdomyolysis in Children: Single Center Experience. Child. Kidney Dis. 2018, 22, 52–57. [Google Scholar] [CrossRef]
- Gilpin, S.; Byers, M.; Byrd, A.; Cull, J.; Peterson, D.; Thomas, B.; Jacobson, P. Rhabdomyolysis as the Initial Presentation of SARS-CoV-2 in an Adolescent. Pediatrics 2021, 147, e2020019273. [Google Scholar] [CrossRef]
- Lim, Y.S.; Cho, H.; Lee, S.T.; Lee, Y. Acute Kidney Injury in Pediatric Patients with Rhabdomyolysis. Korean J. Pediatr. 2018, 61, 95. [Google Scholar] [CrossRef]
- Watemberg, N.; Leshner, R.L.; Armstrong, B.A.; Lerman-Sagie, T. Acute Pediatric Rhabdomyolysis. J. Child. Neurol. 2000, 15, 222–227. [Google Scholar] [CrossRef]
- Agharokh, L.; Zaniletti, I.; Yu, A.G.; Lee, B.C.; Hall, M.; Williams, D.J.; Wilson, K.M. Trends in Pediatric Rhabdomyolysis and Associated Renal Failure: A 10-Year Population-Based Study. Hospital Pediatrics 2022, 12, 718–725. [Google Scholar] [CrossRef]
- Kuok, C.I.; Chan, W.K.Y. Acute Kidney Injury in Pediatric Non-Traumatic Rhabdomyolysis. Pediatr. Nephrol. 2021, 36, 3251–3257. [Google Scholar] [CrossRef]
- Harmer, M.J.; Nijloveanu, V.; Thodi, E.; Ding, W.Y.; Longthorpe, C.; Fenton-Jones, M.; Hogg, K.; Day, A.; Platt, C. Paediatric Rhabdomyolysis: A UK Centre’s 10-year Retrospective Experience. J. Paediatr. Child. Health 2023, 59, 346–351. [Google Scholar] [CrossRef] [PubMed]
- Yoo, S.; Cho, M.H.; Baek, H.S.; Song, J.Y.; Lee, H.S.; Yang, E.M.; Yoo, K.H.; Kim, S.J.; Shin, J.I.; Lee, K.H.; et al. Characteristics of Pediatric Rhabdomyolysis and the Associated Risk Factors for Acute Kidney Injury: A Retrospective Multicenter Study in Korea. Kidney Res. Clin. Pract. 2021, 40, 673–686. [Google Scholar] [CrossRef] [PubMed]
- Zutt, R.; Van Der Kooi, A.J.; Linthorst, G.E.; Wanders, R.J.A.; De Visser, M. Rhabdomyolysis: Review of the Literature. Neuromuscul. Disord. 2014, 24, 651–659. [Google Scholar] [CrossRef]
- Kellum, J.A.; Lameire, N.; for the KDIGO AKI Guideline Work Group. Diagnosis, Evaluation, and Management of Acute Kidney Injury: A KDIGO Summary (Part 1). Crit. Care 2013, 17, 204. [Google Scholar] [CrossRef] [PubMed]
- Holliday, M.A.; Segar, W.E. The Maintenance Need for Water in Parenteral Fluid Therapy. Pediatr. Anesth. 1995, 5, 96. [Google Scholar] [CrossRef]
- Yao, Z.; Yuan, P.; Hong, S.; Li, M.; Jiang, L. Clinical Features of Acute Rhabdomyolysis in 55 Pediatric Patients. Front. Pediatr. 2020, 8, 539. [Google Scholar] [CrossRef]
- Gelbart, B.; DeMarco, R.; David Hussey, A.; Namachivayam, S.P.; McRae, R.; Quinlan, C.; Duke, T. Rhabdomyolysis in a Tertiary PICU: A 10-Year Study. Pediatr. Crit. Care Med. 2018, 19, e51–e57. [Google Scholar] [CrossRef]
- Olerud, J.E. Incidence of Acute Exertional Rhabdomyolysis: Serum Myoglobin and Enzyme Levels as Indicators of Muscle Injury. Arch. Intern. Med. 1976, 136, 692. [Google Scholar] [CrossRef] [PubMed]
AKI | No AKI | Overall | p-Value | |
---|---|---|---|---|
(n = 8) | (n = 104) | (n = 112) | ||
Age (years) | <0.001 | |||
Mean (SD) | 17.0 (1.85) | 13.3 (5.47) | 13.5 (5.38) | |
Sex | 0.999 | |||
Male | 7 (87.5%) | 82 (78.8%) | 89 (79.5%) | |
Female | 1 (12.5%) | 22 (21.2%) | 23 (20.5%) | |
Race/Ethnicity | 0.999 | |||
Non-Hispanic White | 4 (50.0%) | 52 (50.0%) | 56 (50.0%) | |
Non-Hispanic Black | 1 (12.5%) | 14 (13.5%) | 15 (13.4%) | |
Hispanic | 2 (25.0%) | 26 (25.0%) | 28 (25.0%) | |
Other | 1 (12.5%) | 12 (11.5%) | 13 (11.6%) | |
Insurance | 0.829 | |||
Public, Charity or None | 2 (25.0%) | 45 (43.3%) | 47 (42.0%) | |
Private | 6 (75.0%) | 59 (56.7%) | 65 (58.0%) | |
Location of Pain | 0.568 | |||
Lower extremity | 4 (50.0%) | 43 (41.3%) | 47 (42.0%) | |
Upper extremity | 1 (12.5%) | 21 (20.2%) | 22 (19.6%) | |
Other or multiple locations | 3 (37.5%) | 40 (38.5%) | 43 (38.4%) | |
Etiology | 0.129 | |||
Exertional | 8 (100%) | 59 (56.7%) | 67 (59.8%) | |
Viral | 0 (0%) | 36 (34.6%) | 36 (32.1%) | |
Other * | 0 (0%) | 9 (8.7%) | 9 (8.0%) | |
Peak Creatine Kinase (IU/L) | 0.016 | |||
Median [Min, Max] | 2040 [1060, 32,000] | 5710 [1040, 242,000] | 4890 [1040, 242,000] | |
Maximum creatinine (mg/dL) | 0.002 | |||
Median [Min, Max] | 1.40 [1.00, 2.39] | 0.765 [0.250, 1.70] | 0.800 [0.250, 2.39] | |
Maximum creatinine/reference value | 0.131 | |||
Median [Min, Max] | 1.75 [1.34, 1.93] | 0.650 [0.240, 1.34] | 0.685 [0.240, 1.93] | |
Myoglobinuria | 0.41 | |||
Present | 3 (37.5%) | 25 (24.0%) | 28 (25.0%) | |
Absent | 5 (62.5%) | 79 (76.0%) | 84 (75.0%) |
AKI | No AKI | Overall | p-Value | |
---|---|---|---|---|
(n = 8) | (n = 104) | (n = 112) | ||
Total number of fluid boluses | 0.454 | |||
Median [Min, Max] | 2.00 [1.00, 3.00] | 1.50 [0, 4.00] | 1.63 [0, 4.00] | |
Maintenance fluid type | 0.029 | |||
Normal saline | 3 (37.5%) | 79 (76.0%) | 82 (73.2%) | |
Lactated Ringer’s solution | 0 (0%) | 2 (1.9%) | 2 (1.8%) | |
Mixed fluids * | 2 (25%) | 4 (3.8%) | 6 (5.4%) | |
No continuous fluids prescribed | 3 (37.5%) | 19 (18.3%) | 22 (19.6%) | |
Fluid rate/calculated maintenance rate | 0.468 | |||
Median [Min, Max] | 2.00 [1.50, 2.00] | 1.50 [1.00, 4.25] | 1.50 [1.00, 4.25] | |
Bicarbonate administration | 0.376 | |||
Present | 3 (37.5%) | 23 (22.1%) | 26 (23.2%) | |
Absent | 5 (62.5%) | 81 (77.9%) | 86 (76.8%) | |
Length of Stay (h) | 0.064 | |||
Mean (SD) | 28.5 (35.2) | 56.5 (51.1) | 54.5 (50.5) |
Characteristic | OR | 95%CI | p-Value |
---|---|---|---|
Age (years) | 1.44 | 1.11–2.19 | 0.03 |
Sex | |||
Male | — | — | — |
Female | 0.89 | 0.02–13.65 | 0.94 |
Peak Creatine Kinase (IU/L) | 1.00 | 0.99–1.00 | — |
Bicarbonate administration | |||
Absent | — | — | — |
Present | 16.02 | 1.44–228.69 | 0.03 |
Myoglobinuria | |||
Absent | — | — | — |
Present | 22.98 | 2.05–432.48 | 0.02 |
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Pinto, J.M.; Ison, G.; Kasselman, L.J.; Naganathan, S. Acute Kidney Injury in Rhabdomyolysis: A 5-Year Children’s Hospital Network Study. Healthcare 2024, 12, 1717. https://doi.org/10.3390/healthcare12171717
Pinto JM, Ison G, Kasselman LJ, Naganathan S. Acute Kidney Injury in Rhabdomyolysis: A 5-Year Children’s Hospital Network Study. Healthcare. 2024; 12(17):1717. https://doi.org/10.3390/healthcare12171717
Chicago/Turabian StylePinto, Jamie M., Gregory Ison, Lora J. Kasselman, and Srividya Naganathan. 2024. "Acute Kidney Injury in Rhabdomyolysis: A 5-Year Children’s Hospital Network Study" Healthcare 12, no. 17: 1717. https://doi.org/10.3390/healthcare12171717