Rabdomiyoliz
Özet
Rabdomiyoliz, kas nekrozu sonucu hücre içi bileşenlerin dolaşıma salınması ile karakterize bir sendromdur. Tipik olarak kreatinin kinaz (CK) seviyeleri belirgin şekilde yükselir, kas ağrısı ve miyoglobinüri görülür. Hastalığın şiddeti, serum kas enzimlerinin asemptomatik yükselmelerinden, aşırı enzim yükselmeleri, elektrolit bozuklukları ve akut böbrek yetmezliği hatta ölüme kadar gidebilen bir aralıkta değişkenlik göstermektedir. Rabdomiyolizin gerçek insidansı, hafif vakaların net olarak tanınamaması ve raporlamalarda olan eksiklikler nedeniyle net olarak bilinmemekle birlikte; Amerika Birleşik Devletleri kayıtlarında her yıl ortalama 26 bin vaka olduğu bildirilmektedir. Rabdomiyoliz nedeniyle akut böbrek yetmezliği (ABY) gelişen olgularda mortalitenin yaklaşık %80 olduğu bildirilmiştir. ABY, rabdomiyolizin en önemli komplikasyonlarından biridir. Olguların %15-50’sinde görülebilmektedir. CK seviyesi 15-20 bin IU/L’nin altında olan olgularda ABY gelişme riski düşüktür. Kas ağrısı, halsizlik ve koyu renkte idrar triadı ile başvuran olgularda rabdomiyolizden şüphelenilmelidir. Ancak bu üçlünün birlikte görülme oranı düşüktür. Bu nedenle miyaljileri olan ve idrarda pigmentürisi olan olgularda tanısal değerlendirme yapılmalıdır. Akut kas güçsüzlüğü ve belirgin CK yüksekliği olan olgularda rabdomiyoliz akla getirilmelidir. Rabdomiyolize neden olan etyolojik nedenin ortadan kaldırılması tedavinin esasıdır. Ayrıca ABY ve elektrolit imbalansına müdahale bir sonraki önemli tedavi basamağıdır. ABY’yi önlemede genel tedavi önerisi yeterli hidrasyon ve intratübüler nekrozun oluşumunun önlenmesidir.
Referanslar
Giannoglou GD, Chatzizisis YS, Misirli G. The syndrome of rhabdomyolysis: Pathophysiology and diagnosis. Eur J Intern Med 2007; 18:90.
Khan FY. Rhabdomyolysis: a review of the literature. Neth J Med 2009; 67:272.
Gabow PA, Kaehny WD, Kelleher SP. The spectrum of rhabdomyolysis. Medicine (Baltimore) 1982; 61:141.
Melli G, Chaudhry V, Cornblath DR. Rhabdomyolysis: an evaluation of 475 hospitalized patients. Medicine (Baltimore) 2005; 84:377.
Korff S, Katus HA, Giannitsis E. Differential diagnosis of elevated troponins. Heart. 2006 Jul;92(7):987-93. doi: 10.1136/hrt.2005.071282. PMID: 16775113; PMCID: PMC1860726.
Jaffe AS, Vasile VC, Milone M, Saenger AK, Olson KN, Apple FS. Diseased skeletal muscle: a noncardiac source of increased circulating concentrations of cardiac troponin T. J Am Coll Cardiol. 2011 Oct 18;58(17):1819-24. doi: 10.1016/j.jacc.2011.08.026. Epub 2011 Sep 29. PMID: 21962825.
Torres PA, Helmstetter JA, Kaye AM, Kaye AD. Rhabdomyolysis: pathogenesis, diagnosis, and treatment. Ochsner J 2015; 15:58.
Long B, Koyfman A, Gottlieb M. An evidence-based narrative review of the emergency department evaluation and management of rhabdomyolysis. Am J Emerg Med 2019; 37:518.
Chavez LO, Leon M, Einay S, Varon J. Beyond muscle destruction: A Systematic Review of Rhabdomyolysis For Clinical Practice. Critical care . 2016; 20:135.
Chatzizisis YS, Misirli G, Hatzitolios AI, Giannoglou GD. The syndrome of rhabdomyolysis: complications and treatment. Eur J Intern Med. 2008 Dec;19(8):568-74.
Bywaters EGL, Beall D. Crush Injuries with Impairment of Renal Function. British Medical Journal 1941; 1:427–432.
Cleak MJ, Eston RG. Delayed onset muscle soreness: mechanisms and management. J Sports Sci. 1992 Aug;10(4):325-41. doi: 10.1080/02640419208729932. PMID: 1518094.
Coban YK. Rhabdomyolysis, compartment syndrome and thermal injury. World J Crit Care Med. 2014 Feb 4;3(1):1-7.
Huerta-Alardín AL, Varon J, Marik PE. Bench-to-bedside review: Rhabdomyolysis –an overview for clinicians. Critical care 2005; 9:158–169.
Vanholder R, Sever MS, Erek E, Lameire N. Rhabdomyolysis. J Am Soc Nephrol 2000; 11:1553–1561.
Punukollu G, Gowda RM, Khan IA, Mehta NJ, Navarro V, Vasavada BC, Sacchi TJ. Elevated serum cardiac troponin I in rhabdomyolysis. Int J Cardiol. 2004 Jul;96(1):35-40. doi: 10.1016/j.ijcard.2003.04.053. PMID: 15203259.
Zutt R, van der Kooi AJ, Linthorst GE, Wanders RJ, de Visser M. Rhabdomyolysis: review of the literature. Neuromuscul Disord. 2014 Aug;24(8):651-9.
Kruger D, Han J. Assessing acquired rhabdomyolysis in adults. JAAPA. 2017 Jan;30(1):20-26.
Cervellin G, Comelli I, Benatti M, Sanchis-Gomar F, Bassi A, Lippi G. Non-traumatic rhabdomyolysis: Background, laboratory features, and acute clinical management. Clin Biochem. 2017 Aug;50(12):656-662.
Nance JR, Mammen AL. Diagnostic evaluation of rhabdomyolysis. Muscle Nerve. 2015 Jun;51(6):793-810.
Koch AJ, Pereira R, Machado M. The creatine kinase response to resistance exercise. J Musculoskelet Neuronal Interact. 2014 Mar;14(1):68-77.
Melli G, Chaudhry V, Cornblath DR. Rhabdomyolysis: an evaluation of 475 hospitalized patients. Medicine (Baltimore). 2005 Nov;84(6):377-385.
Veenstra J, Smit WM, Krediet RT, Arisz L. Relationship between elevated creatine phosphokinase and the clinical spectrum of rhabdomyolysis. Nephrol Dial Transplant. 1994;9(6):637-41.
Bosch X, Poch E, Grau JM. Rhabdomyolysis and acute kidney injury. N Engl J Med. 2009 Jul 2;361(1):62-72.
Ward M. Factors predictive of acute renal failure in rhabdomyolysis. Arch Intern Med 1988; 148:1553–1557.
Khan Sana F. Chapter 11. Rhabdomyolysis. In: CURRENT Diagnosis & Treatment: Nephrology & Hypertension. 2’e ed. The McGraw-Hill Companies; 2018:143–148.
Fernandez WG, Hung O, Bruno GR, Galea S, Chiang WK. Factors predictive of acute renal failure and need for hemodialysis among ED patients with rhabdomyolysis. Am J Emerg Med 2005;23(1):1–7.
De Meijer AR, Fikkers BG, de Keijzer MH, van Engelen BG, Drenth JPH. Serum creatine kinase as predictor of clinical course in rhabdomyolysis: a 5-year intensive care survey. Intensive Care Med 2003;29(7):1121–1125.
Stahl K, Rastelli E, Schoser B. A systematic review on the definition of rhabdomyolysis. J Neurol. 2020 Apr;267(4):877-882.
Antons KA, Williams CD, Baker SK, Phillips PS. Clinical perspectives of statin-induced rhabdomyolysis. Am J Med. 2006 May;119(5):400-9.
Pasternak RC, Smith SC Jr, Bairey-Merz CN, Grundy SM, Cleeman JI, Lenfant C et al. ACC/AHA/NHLBI Clinical Advisory on the Use and Safety of Statins. Stroke. 2002 Sep;33(9):2337-41.
Zimmerman JL, Shen MC. Rhabdomyolysis. Contemporary Reviews in Critical Care Medicine. CHEST 2013;144(3):1058–1065.
Melli G, Chaudhry V, Cornblath DR. Rhabdomyolysis: an evaluation of 475 hospitalized patients. Medicine 2005; 84:377–385.
Llach F, Felsenfeld AJ, Haussler MR. The pathophysiology of altered calcium metabolism in rhabdomyolysis-induced acute renal failure. Interactions of parathyroid hormone, 25-hydroxycholecalciferol, and 1,25-dihydroxycholecalcif- erol. N Engl J Med 1981; 305:117.
Akmal M, Bishop JE, Telfer N, et al. Hypocalcemia and hypercalcemia in patients with rhabdomyolysis with and without acute renal failure. J Clin Endocrinol Metab 1986; 63:137.
McMahon GM, Zeng X, Waikar SS. A Risk Prediction Score for Kidney Failure or Mortality in Rhabdomyolysis. JAMA Intern Med 2013 October 28;173(19):1821–1828.
Simpson JP, Taylor A, Sudhan N, Menon DK, Lavinio A. Rhabdomyolysis and acute kidney injury: creatine kinase as a prognostic marker and validation of the McMahon Score in a 10-year cohort. Eur J Anaesthesiol 2016; 33:906–912.
Petejova N, Martinek A. Acute kidney injury due to rhabdomyolysis and renal replacement therapy: a critical review. Critical care 2014; 18:224.
Scharman EJ, Troutman WG. Prevention of kidney injury following rhabdomyolysis: A Systematic Review. Ann Phar- macothe 2013; 47:90–105.
Ron D, Taitelman U, Michaelson M, et al. Prevention of acute renal failure in traumatic rhabdomyolysis. Arch Intern Med 1984; 144:277–280.
Bieber Scott D. Jonathan Ashley Jefferson. “Chapter 12. Rhabdomyolysis.” Nephrology Secrets. 4th ed. Elsevier; 2019:89–93.
Referanslar
Giannoglou GD, Chatzizisis YS, Misirli G. The syndrome of rhabdomyolysis: Pathophysiology and diagnosis. Eur J Intern Med 2007; 18:90.
Khan FY. Rhabdomyolysis: a review of the literature. Neth J Med 2009; 67:272.
Gabow PA, Kaehny WD, Kelleher SP. The spectrum of rhabdomyolysis. Medicine (Baltimore) 1982; 61:141.
Melli G, Chaudhry V, Cornblath DR. Rhabdomyolysis: an evaluation of 475 hospitalized patients. Medicine (Baltimore) 2005; 84:377.
Korff S, Katus HA, Giannitsis E. Differential diagnosis of elevated troponins. Heart. 2006 Jul;92(7):987-93. doi: 10.1136/hrt.2005.071282. PMID: 16775113; PMCID: PMC1860726.
Jaffe AS, Vasile VC, Milone M, Saenger AK, Olson KN, Apple FS. Diseased skeletal muscle: a noncardiac source of increased circulating concentrations of cardiac troponin T. J Am Coll Cardiol. 2011 Oct 18;58(17):1819-24. doi: 10.1016/j.jacc.2011.08.026. Epub 2011 Sep 29. PMID: 21962825.
Torres PA, Helmstetter JA, Kaye AM, Kaye AD. Rhabdomyolysis: pathogenesis, diagnosis, and treatment. Ochsner J 2015; 15:58.
Long B, Koyfman A, Gottlieb M. An evidence-based narrative review of the emergency department evaluation and management of rhabdomyolysis. Am J Emerg Med 2019; 37:518.
Chavez LO, Leon M, Einay S, Varon J. Beyond muscle destruction: A Systematic Review of Rhabdomyolysis For Clinical Practice. Critical care . 2016; 20:135.
Chatzizisis YS, Misirli G, Hatzitolios AI, Giannoglou GD. The syndrome of rhabdomyolysis: complications and treatment. Eur J Intern Med. 2008 Dec;19(8):568-74.
Bywaters EGL, Beall D. Crush Injuries with Impairment of Renal Function. British Medical Journal 1941; 1:427–432.
Cleak MJ, Eston RG. Delayed onset muscle soreness: mechanisms and management. J Sports Sci. 1992 Aug;10(4):325-41. doi: 10.1080/02640419208729932. PMID: 1518094.
Coban YK. Rhabdomyolysis, compartment syndrome and thermal injury. World J Crit Care Med. 2014 Feb 4;3(1):1-7.
Huerta-Alardín AL, Varon J, Marik PE. Bench-to-bedside review: Rhabdomyolysis –an overview for clinicians. Critical care 2005; 9:158–169.
Vanholder R, Sever MS, Erek E, Lameire N. Rhabdomyolysis. J Am Soc Nephrol 2000; 11:1553–1561.
Punukollu G, Gowda RM, Khan IA, Mehta NJ, Navarro V, Vasavada BC, Sacchi TJ. Elevated serum cardiac troponin I in rhabdomyolysis. Int J Cardiol. 2004 Jul;96(1):35-40. doi: 10.1016/j.ijcard.2003.04.053. PMID: 15203259.
Zutt R, van der Kooi AJ, Linthorst GE, Wanders RJ, de Visser M. Rhabdomyolysis: review of the literature. Neuromuscul Disord. 2014 Aug;24(8):651-9.
Kruger D, Han J. Assessing acquired rhabdomyolysis in adults. JAAPA. 2017 Jan;30(1):20-26.
Cervellin G, Comelli I, Benatti M, Sanchis-Gomar F, Bassi A, Lippi G. Non-traumatic rhabdomyolysis: Background, laboratory features, and acute clinical management. Clin Biochem. 2017 Aug;50(12):656-662.
Nance JR, Mammen AL. Diagnostic evaluation of rhabdomyolysis. Muscle Nerve. 2015 Jun;51(6):793-810.
Koch AJ, Pereira R, Machado M. The creatine kinase response to resistance exercise. J Musculoskelet Neuronal Interact. 2014 Mar;14(1):68-77.
Melli G, Chaudhry V, Cornblath DR. Rhabdomyolysis: an evaluation of 475 hospitalized patients. Medicine (Baltimore). 2005 Nov;84(6):377-385.
Veenstra J, Smit WM, Krediet RT, Arisz L. Relationship between elevated creatine phosphokinase and the clinical spectrum of rhabdomyolysis. Nephrol Dial Transplant. 1994;9(6):637-41.
Bosch X, Poch E, Grau JM. Rhabdomyolysis and acute kidney injury. N Engl J Med. 2009 Jul 2;361(1):62-72.
Ward M. Factors predictive of acute renal failure in rhabdomyolysis. Arch Intern Med 1988; 148:1553–1557.
Khan Sana F. Chapter 11. Rhabdomyolysis. In: CURRENT Diagnosis & Treatment: Nephrology & Hypertension. 2’e ed. The McGraw-Hill Companies; 2018:143–148.
Fernandez WG, Hung O, Bruno GR, Galea S, Chiang WK. Factors predictive of acute renal failure and need for hemodialysis among ED patients with rhabdomyolysis. Am J Emerg Med 2005;23(1):1–7.
De Meijer AR, Fikkers BG, de Keijzer MH, van Engelen BG, Drenth JPH. Serum creatine kinase as predictor of clinical course in rhabdomyolysis: a 5-year intensive care survey. Intensive Care Med 2003;29(7):1121–1125.
Stahl K, Rastelli E, Schoser B. A systematic review on the definition of rhabdomyolysis. J Neurol. 2020 Apr;267(4):877-882.
Antons KA, Williams CD, Baker SK, Phillips PS. Clinical perspectives of statin-induced rhabdomyolysis. Am J Med. 2006 May;119(5):400-9.
Pasternak RC, Smith SC Jr, Bairey-Merz CN, Grundy SM, Cleeman JI, Lenfant C et al. ACC/AHA/NHLBI Clinical Advisory on the Use and Safety of Statins. Stroke. 2002 Sep;33(9):2337-41.
Zimmerman JL, Shen MC. Rhabdomyolysis. Contemporary Reviews in Critical Care Medicine. CHEST 2013;144(3):1058–1065.
Melli G, Chaudhry V, Cornblath DR. Rhabdomyolysis: an evaluation of 475 hospitalized patients. Medicine 2005; 84:377–385.
Llach F, Felsenfeld AJ, Haussler MR. The pathophysiology of altered calcium metabolism in rhabdomyolysis-induced acute renal failure. Interactions of parathyroid hormone, 25-hydroxycholecalciferol, and 1,25-dihydroxycholecalcif- erol. N Engl J Med 1981; 305:117.
Akmal M, Bishop JE, Telfer N, et al. Hypocalcemia and hypercalcemia in patients with rhabdomyolysis with and without acute renal failure. J Clin Endocrinol Metab 1986; 63:137.
McMahon GM, Zeng X, Waikar SS. A Risk Prediction Score for Kidney Failure or Mortality in Rhabdomyolysis. JAMA Intern Med 2013 October 28;173(19):1821–1828.
Simpson JP, Taylor A, Sudhan N, Menon DK, Lavinio A. Rhabdomyolysis and acute kidney injury: creatine kinase as a prognostic marker and validation of the McMahon Score in a 10-year cohort. Eur J Anaesthesiol 2016; 33:906–912.
Petejova N, Martinek A. Acute kidney injury due to rhabdomyolysis and renal replacement therapy: a critical review. Critical care 2014; 18:224.
Scharman EJ, Troutman WG. Prevention of kidney injury following rhabdomyolysis: A Systematic Review. Ann Phar- macothe 2013; 47:90–105.
Ron D, Taitelman U, Michaelson M, et al. Prevention of acute renal failure in traumatic rhabdomyolysis. Arch Intern Med 1984; 144:277–280.
Bieber Scott D. Jonathan Ashley Jefferson. “Chapter 12. Rhabdomyolysis.” Nephrology Secrets. 4th ed. Elsevier; 2019:89–93.
