横纹肌溶解致急性肾衰竭3例报告及文献复习

目的：探讨横纹肌溶解致急性肾衰竭的发病机制及有效的治疗方法。方法：分析报道典型的横纹肌溶解导致急性肾衰竭3例患者,并作文献复习。结果：患者均为男性,平均年龄33,3岁,2例大量饮酒（其中1例同时注射海洛因）后,另1例由于一氧化碳中毒。有长时间昏睡史,血压偏低。其中有1例患者的肾活检病理报告：急性肾小管坏死,肾小管内存在大量蛋白栓子;免疫组化证实为肌红蛋白。3例患者入院时均无尿,高钾血症,重度酸中毒,所以予以血液透析及对症治疗,痊愈出院。结论：虽然尿中检测到肌红蛋白是诊断横纹肌溶解的“金标准”,但我们认为肾穿刺活检免疫组化证明肾小管内肌红蛋白栓子可作为诊断横纹肌溶解引起急性肾小管坏死更直接证据。酗酒加注射毒品后引起肌溶解急性肾衰竭的病情较重且复杂,早期血液透析治疗可以减少死亡率。

Rhabdomyolysis and Acute Renal Failure:Three Cases Report and Review

Objective:To study the mechanisms and effective treatment of ARF induced by non-traumatic rhabdomyolysis.Methods:Here we report three patients with ARF caused by rhabdomyolsis and reviewed recent studies.Results:All three patients are male, the mean age was 33.3. 2 of them developed ARF following a heavy binge of alcohol (1 patient got a injection of morphine the same time). The third patient was poisoned by carbon monoxide(CO) and severe coma continued for a long time.We performed kidney biopsy on the patient 1,the pathologic analysis showed the acute tubular necrosis(ATN). The immunochemical histologic study for myoglobulin showed that there are a lot of myoglobulin in Bowman's capsule and tuble. All three patients experienced oliguria and the blood analysis showed that: CPK >4100 IU/L, normal troponin level, hyperkalemia, severe acidosis, hyperphosphatemia,hypocalcemia and hyperuricemia. The serum concentration BUN and Cr rose more rapidly. All three patients were treated with hemodialysis and recovered completely without any complications.Conclusion:Although myoglobulinuria is "a golden standard" for the diagnosis of rhabdomyolysis, we concluded that kidney biopsy should be performed in these patients for differential diagnosis and evaluation. Early dialysis intervention is necessary and can decrease the mortality.