Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia
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Rhabdomyolysis is a clinical and biochemical syndrome that occurs when skeletal muscle cells disrupt and release creatine phosphokinase (CK), lactate dehydrogenase (LDH), and myoglobin into the interstitial space and plasma. The main causes of rhabdomyolysis include direct muscular injury, strenuous exercise, drugs, toxins, infections, hyperthermia, seizures, meta-bolic and/or electrolyte abnormalities, and endocrinopathies. Acute kidney injury (AKI) occurs in 33-50% of patients with rhabdomyolysis. ⋯ Serum CK five times higher than the normal value usually confirms rhabdomyolysis. Early diagnosis and saline volume expansion may reduce the risk of AKI. Further studies are necessary to establish the importance of bicarbonate and mannitol in the prevention of AKI due to rhabdomyolysis.
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Saudi J Kidney Dis Transpl · Jul 2008
EditorialRenal replacement therapy in acute kidney injury: which method to use in the intensive care unit?
Over the last three decades the treatment options for patients with acute kidney injury (AKI) requiring renal replacement therapy (RRT) have expanded from basic acute peritoneal dialysis and intermittent hemodialysis (IHD), to now include a variety of continuous modalities (CRRT), ranging from hemofiltration, dialysis and/or hemodiafiltration, and a variety of hybrid therapies, variously described as extended daily dialysis and/or hemodiafiltration, with the possibility of additional adjunct therapies encompassing plasma separation and adsorption techniques. Current evidence does not support that one modality is superior to any other in terms of patients' survival in the intensive care unit, or at discharge. There have been two prospective audits, which have reported improved renal recovery in the survivors who were treated by CRRT rather than IHD, but this has not been confirmed in randomized controlled trials. Thus the choice of RRT modality should be guided by the individual patients' clinical status, the medical and nursing expertise in the local intensive care unit, and the availability of RRT modality.