Acute kidney injury associated with rhabdomyolysis after coronary artery bypass graft: a case report and review of the literatures

BMC Research Notes

Abdulwahid Al Mulla¹  Rasheed A Pattath¹  Amr S Omar²  Suraj Sudarsanan¹ 

[1] Department of Cardiothoracic Surgery/Cardiac Anaesthesia & ICU Section, Heart Hospital, Hamad Medical Corporation, Doha (PO: 3050), Qatar;Department of Critical Care Medicine, Beni Suef, Egypt

关键词: Prolonged surgery;    Coronary artery bypasses graft;    Rhabdomyolysis;    Acute kidney injury;   

Others  :  1134274
DOI  :  10.1186/1756-0500-7-152

 received in 2013-05-19, accepted in 2014-03-07,  发布年份 2014

【 摘 要 】

Background

Post-operative rhabdomyolysis is a well-known complication, especially after bariatric and orthopaedic surgeries. There are few published reports of rhabdomyolysis following cardiac surgery. Acute kidney injury had been distinguished as a serious complication of cardiac surgery. We report a case of 55-years-old male patient who developed rhabdomyolysis precipitated acute kidney injury after coronary artery bypass graft.

Case presentation

The patient underwent urgent coronary artery bypass graft surgery, with a long duration of surgery due to technical difficulty during grafting. He developed rhabdomyolysis induced acute kidney injury necessitating hemodialysis. The patient in turn developed heart failure, which along with acute kidney injury lead to prolonged ventilation. There was supervening sepsis with prolonged intensive care unity stay and eventually prolonged hospitalization. The peak creatine kinase level was 39000 IU/mL and peak myoglobin was 40000 ng/ml. Reviewing the patient, surgery was prolonged due to technical difficulties encountered during grafting, leading to rhabdomyolysis induced acute kidney injury. The pre-operative use of statins by the patient could also have contributed to the development of rhabdomyolysis. He developed post-operative right heart failure and sepsis. The patient’s renal function gradually improved over 4 week’s duration. Favorable outcome could be achieved but after prolonged course of renal replacement therapy in the form of hemodialysis.

Conclusion

Prolonged duration of surgery is a well-recognized risk factor in the development of rhabdomyolysis. Early recognition of rhabdomyolysis induced acute kidney injury is important in reducing the post-operative morbidity and mortality in patients. A protocol based approach could be applied for early recognition and management.

【 授权许可】

   
2014 Sudarsanan et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Santulli G: Epidemiology of cardiovascular disease in the 21st century: updated numbers and updated facts. J Cardiovasc Dis 2013, 1:1-2.
• [2]Visweswaran P, Guntupalli J: Rhabdomyolysis. Crit Care Clin 1999, 15(2):415-428.
• [3]Dayer-Berenson L: Rhabdomyolysis: a comprehensive guide. ANNA J 1994, 21(1):15-18.
• [4]Biswas S, Gnanasekaran I, Ivatury R, Simon R, Patel A: Exaggerated lithotomy position-related Rhabdomyolysis. Am Surg 1997, 63(4):361-364.
• [5]Hiratsuka Y, Ishii T, Takeuchi F, Okadome A, Taira H: Risk of elevated creatine kinase and myoglobulinemia due to incised muscles in patients who underwent urological surgery. J Urol 2003, 170(1):119-121.
• [6]Miller CC III, Villa MA, Sutton J, Lau D, Keyhani K, Estrera AL, Safi HJ: Serum myoglobin and renal morbidity and mortality following thoracic and thoraco-abdominal aortic repair: does rhabdomyolysis play a role? Eur J Vasc Endovasc Surg 2009, 37(4):388-394.
• [7]Collier B, Duke BE III: Postoperative rhabdomyolysis with bariatric surgery. Obes Surg 2003, 13(6):941-943.
• [8]Kong SS, Ho ST, Huang GS, Cherng CH, Wong CS: Rhabdomyolysis after a long-term thoracic surgery in right decubitus position. Acta Anaesthesiol Sin 2000, 38(4):223-228.
• [9]Prabhu M, Samra S: An unusual case of rhabdomyolysis following surgery in prone position. J Neurosurg Anesthesiol 2000, 12(4):359-363.
• [10]Torres-Villalobos G, Kimura E, Mosqueda J, García-García E, Domínguez-Cherit G, Herrera MF: Pressure-induced rhabdomyolysis after bariatric surgery. Obes Surg 2003, 13(2):297-301.
• [11]Benedetto U, Angeloni E, Luciani R, Refice S, Stefanelli M, Comito C, Roscitano A, Sinatra R: Acute kidney injury after coronary artery bypass grafting: does rhabdomyolysis play a role? J Thorac Cardiovasc Surg 2010, 140(2):464-470.
• [12]Conlon PJ, Stafford-Smith M, White WD, Newman MF, King S, Winn MP, Landolfo K: Acute renal failure following cardiac surgery. Nephrol Dial Transplant 1999, 14(5):1158-1162.
• [13]Hajjar L, Grande S, Galas F, Roquim A, Sampaio L, Auler J: Risk factors and outcome of Rhabdomyolysis after cardiac surgery. Crit Care 2008, 12(2):470.
• [14]Mehta R, Kellum J, Shah S, Molitoris B, Ronco C, Warnock D, Levin A: Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007, 11(2):R31. BioMed Central Full Text
• [15]Rodríguez-Capote K, Balion CM, Hill SA, Cleve R, Yang L, El Sharif A: Utility of urine myoglobin for the prediction of acute renal failure in patients with suspected rhabdomyolysis: a systematic review. Clin Chem 2009, 55(12):2190-2197.
• [16]Rao V, Ivanov J, Weisel RD, Ikonomidis JS, Christakis GT, David TE: Predictors of low cardiac output syndrome after coronary artery bypass. Eur J Vasc Endovasc Surg 1996, 112(1):38-51.
• [17]Chowdhury UK, Malik V, Yadav R, Seth S, Ramakrishnan L, Kalaivani M, Kakani M: Myocardial injury in coronary artery bypass grafting: On-pump versus off-pump comparison by measuring high-sensitivity C-reactive protein, cardiac troponin I, heart-type fatty acid–binding protein, creatine kinase-MB, and myoglobin release. J Thorac Cardiovasc Surg 2008, 135(5):1110-1119.
• [18]Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R: European system for cardiac operative risk evaluation (EuroSCORE). Eur J Vasc Endovasc Surg 1999, 16(1):9-13.
• [19]Maccario M, Fumagalli C, Dottori V, Grasso AM, Agostini M, Parodi E, Passerone G: The association between rhabdomyolysis and acute renal failure in patients undergoing cardiopulmonary bypass. J Cardiovasc Surg 1996, 37(2):153.
• [20]Zanardo G, Michielon P, Paccagnella A, Rosi P, Simini G: Acute renal failure in the patient undergoing cardiac operation. Prevalence, mortality rate, and main risk factors. J Thorac Cardiovasc Surg 1994, 107.
• [21]Mangos GJ, Horton D, Brown MA, Trew P, Chan WYL, Whitworth JA: Acute renal failure following cardiac surgery: incidence, outcomes and risk factors. Aus N Z J Med 1995, 25(4):284-289.
• [22]Goldberg M, Stecker JF Jr, Scarff JE Jr, Wombolt DG: Rhabdomyolysis associated with urethral stricture repair: report of a case. J Urol 1980, 124(5):730.
• [23]Nimmo GR, Stewart SM, English PJ: Myoglobinuric acute renal failure associated with major urological surgery—An avoidable problem? Intensive Care Med 1988, 14(3):244-245.
• [24]Warren JD, Blumbergs PC, Thompson PD: Rhabdomyolysis: a review. Muscle Nerve 2002, 25(3):332-347.
• [25]de Menezes Ettinger JE, dos Santos Filho PV, Azaro E, Melo CA, Fahel E, Batista PB: Prevention of rhabdomyolysis in bariatric surgery. Obes Surg 2005, 15:874-879.
• [26]Wilhelmi M, Winterhalter M, Fischer S, Walles T, Zuk J, Strüber M, Haverich A: Massive postoperative rhabdomyolysis following combined CABG/abdominal aortic replacement: a possible association with HMG-CoA reductase inhibitors. Cardiovasc Drugs Ther 2002, 16(5):471-475.
• [27]Kulik A, Ruel M: Statins and coronary artery bypass graft surgery: preoperative and postoperative efficacy and safety. Exp Opin Drug Saf 2009, 8(5):559-571.
• [28]Bray RJ: Propofol infusion syndrome in children. Paediatr Anaesth 1998, 8:491-499.
• [29]Singh U, Scheld WM: Infectious etiologies of rhabdomyolysis: three case reports and review. Clin Infect Dis 1996, 22(4):642-649.
• [30]Olsson D, Sartipy U, Braunschweig F, Holzmann MJ: Acute kidney injury following coronary artery bypass surgery and long-term risk of heart failure. Circ Heart Fail 2013, 6(1):83-90.
• [31]Gabow PA, Kaehny WD, Kelleher SP: The spectrum of rhabdomyolysis. Medicine (Baltimore) 1982, 61(3):141-152.
• [32]Shapiro ML, Baldea A, Luchette FA: Rhabdomyolysis in the intensive care unit. J Intensive Care Med 2012, 27(6):335-342.
• [33]El-Abdellati E, Eyselbergs M, Sirimsi H, Van Hoof V, Wouters K, Verbrugghe W, Jorens PG: An observational study on rhabdomyolysis in the intensive care unit. Exploring its risk factors and main complication: acute kidney injury. Ann Intensive Care 2013, 3(1):1-8. BioMed Central Full Text