L-Carnitine Ameliorates Glycerol-Induced Myoglobinuric Acute Renal Failure in Rats

There is increasing evidence indicating that oxidative stress plays an important role in the pathogenesis of rhabdomyolysis-induced myoglobinuric acute renal failure (ARF). During times of war and natural disasters, myoglobinuric ARF can assume epidemic proportions. Thus, early and effective renoprotective treatments are of utmost importance. It has been shown that L-carnitine, used as a safe and effective nutritional supplement for more than three decades, is effective in preventing renal injury in many renal injury models involving oxidative stress. The present study was performed to investigate the effects of L-carnitine in an experimental model of myoglobinuric ARF. Four groups of rats were employed in this study: group 1 served as a control; group 2 was given glycerol (10 mL/kg, i.m.); group 3 was given glycerol plus L-carnitine (100 mg/kg, i.p.), starting at the same time as the glycerol injection; group 4 was given glycerol plus L-carnitine (100 mg/kg, i.p.), starting 48h before the glycerol injection. After glycerol injections, the i.p. injections of L-carnitine were repeated every 24h for four days. Ninety-six hours after glycerol injections, blood samples and kidney tissues were taken from the anesthetized rats. Urea and creatinine levels in plasma, N-acetyl-beta-D-glucosaminidase activity in urine, and malondialdehyde levels and catalase enzyme activity in kidney tissue were determined. Histopathological changes and iron accumulation in the kidney tissue were evaluated. In this study, glycerol administration led to marked renal oxidative stress, as well as severe functional and morphological renal deterioration. L-carnitine, possibly via its antioxidant properties, ameliorates glycerol-induced myoglobinuric kidney injury.     

Experimental Myoglobinuric Acute Renal Failure: The Effect of Vitamin C

During times of war and natural disasters, rhabdomyolysis-induced myoglobinuric acute renal failure (ARF) can assume epidemic proportions. Free radicals play an important role in the pathogenesis of myoglobinuric ARF. Vitamin C is a major antioxidant, scavenging free radicals. We have not found any studies on the effect of vitamin C on myoglobinuric ARF. Thus, we aimed to investigate the effects of vitamin C on the myoglobinuric ARF formed by glycerol in rats. Three groups of rats were employed in this study. Group 1 served as control, group 2 was given 50% glycerol (10 mL/kg, i.m.), and group 3 was given glycerol plus vitamin C (20 mg/kg, i.p. for four days). Ninety-six hours after glycerol injections, blood samples and kidney tissues were taken from the anesthetized rats. Urea and creatinine levels in plasma; N-acetyl-beta-D-glucosaminidase activity in urine; malondialdehyde levels, superoxide dismutase and catalase enzyme activity in kidney tissue were determined. Histopathological changes and iron accumulation in the kidney tissue were evaluated. In this study, glycerol administration led to marked renal oxidative stress and severe renal functional and morphological deterioration. The treatment of animals with vitamin C partially corrected the renal dysfunction and morphological impairment. In this respect, vitamin C appears to be a promising candidate for the prevention of rhabdomyolysis-induced ARF. Higher dosages of vitamin C than in 20 mg/kg may be beneficial for better functional and morphological recovery in this model ARF.     

Protective Effect of a Bioflavonoid Proanthocyanidin-BP1 in Glycerol-Induced Acute Renal Failure in the Rat: Renal Stereological Study

Renal ischemia as well as oxygen metaholites ploy an important role in renal Injury during myoglobinuric acute renal failure (ARF). On the other hand, flavonoids. a diverse group of constituents naturally occurring in plants, have a strong antioxidative activity, and have been implicated in vascular relaxation. In this study the protective effect of a new bioflavonoid proanthocvanidin-BP1 (BP1), extracted from seeds of grapes, was evaluated in glycerol-induced ARF in rats. Stereological methods were used to quantify changes in renal morphology associated with ARF. Volume density of tubular lumen and intratubular cast formations, nuclear parameters (area, diameter, volume) of epithelial cells in the cortical proximal tubules, and glomerular parameters (surface area, diameter, volume, perimeter) were estimated on kidney sections of rats treated either with 50% glycerol (8 ml/kg i.m.) alone. BP1 (20 mg/kg i.p.) in addition to glycerol, or BP1 alone. It was noted that the volume density of tubular lumen and cast formations were significantly lower (p < 0.001) in kidneys of the rats treated with BP1 in addition to glycerol, compared with those treated with glycerol alone. There were no significant differences in glomerular and nuclear parameters between glycerol treated, and BP1 in addition to glycerol treated rats. Renal function was significantly improved in rats treated with BP1 in addition to glycerol. The results suggest that BP1 is a protective agent in glycerol model of ARF. This effect is probably due to the antioxidative activity of BP1 and reduced toxicity of myoglobin in renal tissue. Moreover, it is possible that the ability of BP1 to protect the kidney is dependent upon renal vascular relaxation. The potential beneficial effects of bioflavonoid-BP1 demonstrated in experimental ARF could be considered in therapy of myoglobinuric ARF.     

The Mechanism of Spleen Injury in Rabbits with Acute Renal Failure

Immune function disorders are common during acute renal failure (ARF), but the mechanisms are unknown. As the spleen is the largest organ of the immune system, we aimed to observe if there are morphological changes in the spleen in rabbits with ARF. In addition, we tried to explore its mechanism from the perspective of oxygen free radicals, nitric oxide (NO), myeloperoxidase (MPO), and membrane pump activities. ARF animal models were established by either hypodermic injection of 1.3 mL/kg bw 1% HgCl₂ or intramuscular injection of 10 mL/kg bw 50% glycerin. Animals were divided into 12 h, 24 h, and 48 h treatment groups with six rabbits in each group. Compared with control animals, congestion was found in the spleen and splenic trabeculae were increased in the two ARF model groups at multiple time points. The malonaldehyde, NO, nitric oxide synthase, and MPO levels in the ARF models were increased compared with the control group at 24 h or 48 h, and the superoxide dismutase and adenosine triphosphatase activities were significantly lower than the levels in the control group at multiple time points. These indices of free radical damage were induced gradually with ARF development, and there were statistically significant differences at different time points. These data suggested that histological damage of spleen during ARF may lead to immune disorders, which might be related to free radical injury, NO excessive release, polymorphonuclear neutrophils (PMN) sequestration, and membrane pump dysfunction.     

Pancreatic Injury in Rabbits with Acute Renal Failure

Background.?Acute renal failure (ARF) is a common critical disorder. To decrease the mortality, it is important to prevent ARF from invading other organs in clinical setting. It is not known whether there is a dysfunction in pancreas during the pathogenesis of ARF. This study aimed to investigate the changes of morphology and function on pancreas in ARF rabbits. Methods.?Sixty rabbits were randomly divided into four groups. The ARF model of groups 1 and 2 rabbits was established by hypodermic injection of 1% HgCl₂ (1.3 mL/kg) and intramuscular injection of 50% glyceritum (10 mL/kg), respectively. The control groups 1 and 2 were injected with same volume of normal saline. After 24 hours, urea and creatinine contents and pancreatic amylase (AMY) activities in serum were measured using an automatic biochemical analyzer; the insulin levels were measured with radioimmunoassay method. Moreover, morphological alterations were examined by light microscopy; free radicals, nitric oxide (NO), and nitric oxide synthase (NOS) in pancreas homogenate were determined.?Results.?Morphological study showed that there were vacuolar degeneration and necrosis in pancreas of ARF for both groups 1 and 2. Compared with corresponding control group, the AMY activity was significantly elevated, whereas the INS values were decreased significantly in ARF groups 1 and 2. Malonaldehyde, NO, and NOS in pancreas homogenate were significantly increased, and superoxide dismutase activity was decreased.?Conclusion.?These data suggested that there were morphological damage of pancreas and disturbance of pancreatic secretion function in rabbits with ARF. Free radicals-injury and NO excessive release may explain the observed dysfunction.     

Acute Renal Failure in Polytraumatized Patients: Prediction of Outcome

Prediction of outcome of acute renal failure (ARF), particularly inpatients with multisystem organ failure (MSOF), is a very important issue and a very difficult task. In patients with ARF as a consequence of severe polytrauma, frequent complications (e.g., sepsis, respiratory insufficiency, DIC, hepatic insufficiency, etc.) contribute to a hyperbolic state, and in the case of synergistic action, they start the mechanism of MSOF. In 33 patients (1 female, 32 male, 38.61 ± 8.79 years) with severe polytrauma acquired in war combat, ARF developed requiring hemodialysis (HD) treatment. Seventeen out of 33 (51.4%) recovered renal function. In 12 out of 33 patients, MSOF occurred with less successful recovery results. The analysis of pathophysiologic mechanisms of MSOF appearance and ARF outcome has shown the importance of blast injuries, bowel injury, respiratory insufficiency requiring assisted ventilation, and sepsis. Although severe hemorrhage and shock are the common mechanism of ARF appearance in these patients, it seems that wounds by themselves can be of great importance, as abdominal wounds are more frequently associated with ARF and MSOF than in other types.     

Acute Renal Failure in the Neonatal Period

Acute renal failure (ARF) is a common problem in the neonatal intensive care unit (NICU). In most cases, ARF is associated with a primary condition such as sepsis, metabolic diseases, perinatal asphyxia and/or prematurity. This retrospective study investigated the course of illness, therapeutic interventions, early prognosis and risk factors associated with development of ARF in the neonatal period. A total of 1311 neonates were treated in our NICU during the 42‐month study period, and 45 of these babies had ARF. This condition was defined as serum creatinine level above 1.5 mg/dL despite normal maternal renal function. The data collected for each ARF case were contributing condition, cause and clinical course of ARF, gestational age and birth weight, age at the time of diagnosis, treatment, presence of perinatal risk factors and need for mechanical ventilation. The frequency of ARF in the NICU during the study period was 3.4%. Premature newborns constituted 31.1% of the cases. The mean birth weight in the group was 2863 ± 1082 g, and the mean age at diagnosis was 6.2 ± 7.4 days. The causes of ARF were categorized as prerenal in 29 patients (64.4%), renal in 14 patients (31.1%) and postrenal in 2 patients (4.4%). Forty‐seven percent of the cases were nonoliguric ARF. Asphyxia was the most common condition that contributed to ARF (40.0%), followed by sepsis/metabolic disease (22.2%) and feeding problems (17.8%). Therapeutic interventions were supportive in 77.8% of the cases, and dialysis was required in the other 22.2%. The mortality rate in the 45 ARF cases was 24.4%. Acute renal failure of renal origin, need for dialysis, and need for mechanical ventilation were associated with significantly increased mortality (p < 0.05). There were no statistical correlations between mortality rate and perinatal risk factors, oliguria, prematurity or blood urea nitrogen and creatinine levels. The study showed that, at our institution, ARF in the neonatal period is frequently associated with preventable conditions, specifically asphyxia, sepsis and feeding problems. Supportive therapy is effective in most cases of neonatal ARF. Acute renal failure of renal origin, need for dialysis, and need for mechanical ventilation were identified as indicators of poor prognosis in these infants. Early recognition of risk factors and rapid effective treatment of contributing conditions will reduce mortality in neonatal ARF.     

去铁胺对缺血性急性肾衰竭大鼠的保护作用

目的：探讨去铁胺（DFO）对缺血性急性肾衰竭（iARF）大鼠的保护作用及其作用机制。方法：雄性Wistar大鼠，随机分成3组：假手术组、手术组、DFO＋手术组，每组各12只。用钳夹大鼠双侧肾蒂45min制成iARF动物模型，DFO＋手术组：缺血前24h给予DFO（200mg／kg）腹腔注射，其余处理同手术组。于缺血再灌注24h后检测血尿素氮（BUN）、肌酐（Scr）、超氧化物歧化酶（SOD）、丙二醛（MDA）的含量以及进行肾组织光镜形态学观察和采用免疫组织化学法测定低氧诱导因子-la（HIF-la）及血红素加氧酶（HO-1）蛋白的表达水平。结果：手术组BUN、Scr升高，SOD下降，MDA升高，HIF-1a、Ho-1中度提高，肾组织结构紊乱。DFO＋手术组除HIF-1a、HO-1含量大幅提高外，尚能显著逆转上述改变，两组间比较具有统计学意义（P〈0.01）。结论：DFO预处理可通过自由基清除和诱导HIF-1及下游基因HO-1过表达从而对iARF大鼠发挥保护作用。     

Melatonin Reduces Nitric Oxide via Increasing Arginase in Rhabdomyolysis-Induced Acute Renal Failure in Rats

Melatonin, the chief secretory product of the pineal gland, is a direct free radical scavenger. In addition to a direct scavenging effect on nitric oxide (NO), its inhibitory effect on nitric oxide synthase (NOS) activity has been also reported. L-arginine is the substrate for both NOS and arginase. It has been suggested that there is a competition between arginase and NOS and that they control each other's level. NO plays a crucial role in the pathogenesis of myoglobinuric acute renal failure (ARF). In this study, the authors aimed to investigate the effect of melatonin on arginase activity, ornithine, and NO levels on the myoglobinuric ARF formed by intramuscular (im) injection of hypertonic glycerol. Forty rats were randomly divided into four groups. Rats in SHAM were given saline, and those in groups ARF, ARF-M5, and ARF-M10 were injected with glycerol (10 mL/kg) im. Concomitant and 24 hours after glycerol injection for the ARF-M5 and ARF-M10 groups, melatonin—5 mg/kg and 10 mg/kg, respectively—was administrated intraperitoneally. Forty-eight hours after the glycerol injection, kidneys of the rats were taken under anesthesia. Arginase activity, ornithine, and NO levels in the kidney tissue were determined. Melatonin had an increasing effect on kidney tissue arginase activities and ornithine levels while decreasing NO concentration. It is possible that besides the direct scavenging effect, the stimulatory effect of melatonin on arginase activity may result in an inhibition of NOS activity and, finally, a decrease in the kidney NO level.     

Expression of Augmenter of Liver Regeneration in Rats with Gentamicin-Induced Acute Renal Failure and Its Protective Effect on Kidney

Augmenter of liver regeneration (ALR) enhances the proliferation of hepatocytes and accelerates recovery from acute liver failure in animal models. ALR is expressed in both the liver and kidney; however, the specific location of ALR expression and its biological effects in the kidney remain unknown. We aimed to investigate the efficacy of ALR in rats with gentamicin (GM)-induced acute renal failure (ARF). Rats were randomized into the normal group, GM+saline group, GM+vehicle group, and GM+rrALR group. Blood urea nitrogen, serum creatinine, and urine beta-N-acetyl-D-glucosaminidase were measured, and histological analyses of the kidneys were performed. The expression of ALR protein was determined by immunohistochemistry and Western blotting. In vitro incorporation of tritiated thymidine was used to measure the proliferation of renal tubular epithelial cells. In normal rats, the expression of ALR protein was faint in the medulla and absent in the cortex. However, in ARF rats, ALR expression increased significantly in both the renal cortex and medulla. Histological analyses revealed that treatment with recombinant rat ALR (rrALR) reduced the extent of injury of tubular cells in the renal cortex. Serum/urine biochemical parameters also showed that renal dysfunction was improved by the administration of rrALR. Intraperitoneal injection of rrALR enhanced the proliferation of tubular cells in vivo. We also confirmed that rrALR could promote the proliferation of renal tubular cells in vitro. These results indicate that rrALR effectively accelerates kidney recovery after ARF induced by gentamicin, and that the protective effect is associated with enhanced proliferation of renal tubular cells.     

钙通道阻断剂在急性肾衰时抗氧自由基损伤的实验研究

通过测定SD大鼠缺血性急性肾衰时肾组织XOD活力和LPO含量的变化。发现由钙依赖蛋白酶激化的XOD活力明显增高,LPO含量亦明显增高。而给予钙通道阻断剂Verapamil组大鼠肾组织内XOD和LPO均降低,肾组织超微结构损害明显减轻,并能改善肾功能,提高存活率。表明Verapamil在急性肾衰时通过抑制XOD活力,减少氧自由基的生成而达到保护肾脏的作用。     

Causes and Prognosis of Acute Renal Failure in Elderly Patients

In this retrospective study, 287 patients with acute renal failureobserved between 1980 and 1985 were divided into 2 groups, accordingto age: group 1 of 65 years or more (n = 100) and group 2 between17 and 64 years (n = 187). In both age groups the whole spectrumof causes of acute renal failure was found, but within thatspectrum a higher incidence of post-renal failure, acute renalvascular disease and of hypovolaemic acute renal failure wasnoted in group 1 versus group 2. On the other hand, pigment-inducedacute renal failure was lower in group 1 (4%) versus group 2(13%). The overall survival was 54% in the elderly versus 56% in theyounger patients (NS). A close relationship between survivaland the number of postadmission complications was found in bothgroups. Interestingly, the presence of severe hypokalaemia (<3.5mmmol/l) and metabolic alkalosis (plasma HCO₃>30 mmol/l)was associated with a very high mortality of 73% and 86% respectivelyin the elderly patients. Complete or incomplete recovery ofrenal function was the same in both age groups. It is concludedthat age alone should not be used as a discriminating factorin therapeutic decisions concerning acute renal failure in anolder patient.     

三七总苷对慢性肾衰竭大鼠肾损害防治作用的实验研究

目的:探讨三七总苷(PNS)对慢性肾衰竭(CRF)大鼠肾损害的防治作用.方法:单侧肾切除加重复阿霉素注射的方法建立CRF大鼠模型,PNS对照组和PNS治疗组随即给予PNS 400 mg·kg-1·d-1灌胃,正常对照组和模型对照组每日给予生理盐水灌胃.4周后处死大鼠,采用日本岛津CL-7200全自动生化分析仪检测Scr、BUN、SUA;采用瑞典AC100三分类血细胞分析仪检测Hb、RBC、HCT;肾组织HE染色后行光镜病理检查.结果:PNS对照组与正常对照组相比,大鼠的一般情况、肾功能、贫血指标及肾组织病理均无统计学差异.模型对照组与正常对照组相比,体重、生存率、RBC、Hb及HCT均显著降低(P＜0.01),肾重量、24 h尿量、Scr、BUN及SUA均显著增高(P＜0.01),肾小球及肾小管间质损害程度较重.PNS治疗组与模型对照组相比,生存率、RBC、Hb及HCT均显著提高(P＜0.01),体重、肾重量及24 h尿量无统计学差异,Scr、BUN及SUA均显著降低(P＜0.01),肾组织病理损害程度明显减轻.结论:PNS可减轻肾小球及肾小管间质损害,改善贫血,提高生存率,有望成为一种能够有效延缓慢性肾衰竭进展的中药.     

Validity of Prediction Scores in Acute Renal Failure Due to Polytrauma

During a 36-month period from 1992 to 1994, 33 patients with severe polytrauma acquired in war combat (1 female, 32 male, 38.61 ± 8.79 years) developed acute renal failure (ARF) which required hemodialysis (HD) treatment. In 12 patients, multiple system organ failure (MSOF) occurred as a complication of either general conditions or septic complications. In 17 patients (51.4%), and in 3 patients with MSOF, recovery of renal function occurred. We compared the outcome of ARF and several predictive scores (APACHE II and ATNISS). The APACHE II score did not correlate with the outcome of ARF, and ATNISS significantly correlated with the outcome of ARF. The maximum value of ATNISS in the patients with lethal outcome was 1.004, and the minimal value with the same outcome was 0.182. Although ATNISS is a very good score of severity, it seems to underestimate very influential factors in patients with severe polytrauma with ARF (MSOF, mechanism of trauma).     

The Effect of Seventy-Two-Hour Continuous Infusion of Long-Acting Natriuretic Peptide on Acute Ischemic Renal Failure in the Rat

Objectives. Atrial natriuretic peptide (ANP_1-28) protects the kidneys against acute renal failure in animals; however, its use in humans has been disappointing. Long-acting natriuretic peptide (LANP_1-30) has natriuretic and diuretic actions similar to ANP_1-28, but it has a longer half-life and a different receptor site. Therefore, this study's aim was to determine if LANP_1-30 has better renal protection than ANP_1-28, which may make it useful in the treatment of acute renal failure. Subjects/Methods. Three groups of male Sprague-Dawley rats were used, each with a body weight between 250-300 gm. Group 1 (ischemia only, n = 6) had a right nephrectomy followed by 30 minutes of left renal pedicle clamping. Group 2 (LANP Peptide treated, n = 7) had renal ischemia similar to Group 1, followed by an intraperitoneal bolus of 10 μg of LANP_1-30 and the placement of mini-osmotic pumps delivering LANP_1-30 at a rate of 1μg/hr for 72 hours. Group 3 (controls, n = 6) was used to measure the baseline creatinine level and had no renal ischemia or surgery. Results. Seventy-two hours post-renal ischemia, the weight loss in the ischemia group was similar to the peptide treated group (7.65 ± 1.14% and 10.03 ± 0.9% body weight loss, respectively, p?=?0.126). The ischemia group had significantly higher creatinine levels compared to the controls (66.3 ± 5.3 versus 30.1 ± 0.9 μmol/L, p?=?0.002). The peptide-treated group had higher creatinine (174.1 ± 77.8 versus 66.3 ± 5.3 μmol/L, p?=?0.035) and LANP_1-30 levels (673.14 ± 69.64 versus 45.83 ± 8.45 pg/mL, p?=?0.001) than the ischemia group. Conclusion. Prolonged use of LANP_1-30 has no renal protective effect.     

Parathyroid Hormone as a Marker for the Differential Diagnosis of Acute and Chronic Renal Failure

It is often difficult to distinguish acute renal failure clinically from chronic renal failure, especially in patients who do not have records of their medical history. We investigated the magnitude of iPTH increase in ARF and the potential role of iPTH as a marker for differential diagnosis of ARF and CRF in new patients referred to our renal unit. We prospectively analyzed 122 (ARF n?=?64, CRF n?=?58) patients referred to our renal unit with serum creatinine higher than 2 mg/dL. ROC curve analysis was performed to investigate role of iPTH for differentiating ARF from CRF. The sensitivity, specificity, and positive predictive value of iPTH in discrimination of ARF and CRF were calculated. There was no statistically significant difference regarding the means of age, sex distribution, and serum chemistry between patients with ARF or CRF. But serum iPTH (p < 0.0001) levels were lower in patients with ARF than in those with CRF. A cutoff, set at 170pg/mL for iPTH to discriminate patients with CRF, yielded a sensitivity of 88% and a specificity of 89%. This study confirms that the iPTH measurement is of clinical value in differentiating acute from chronic renal failure.     

Effects of Exogenous Melatonin on Myoglobinuric Acute Renal Failure in the Rats

Free oxygen radicals and nitric oxide (NO) play a crucial role in the pathogenesis of myoglobinuric acute renal failure (ARF). In this study, we aimed to investigate the effect of melatonin, a potent free radical scavenger, on the myoglobinuric ARF formed by injecting hypertonic glycerol intramuscularly (im). The rats were randomly divided into 4 Groups. Rats in Group 1 were given saline and those in Groups 2, 3, and 4 were injected with glycerol (10 mL/kg) im. Concomitant and 24 hours after glycerol injection Group 3 (5 mg/kg) and Group 4 (10 mg/kg) were administrated melatonin intraperitoneally. Forty‐eight hours after the glycerol injection, the blood and kidneys of the rats were taken under anesthesia. Kidney morphology and the levels of urea, creatinine and nitric oxide metabolites (NO_x) in the plasma and the enzyme activities of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) and the level of malondialdehyde (MDA) in the kidney were determined. In both groups of melatonin administration, there was no protective effect of melatonin. Moreover, melatonin significantly decreased the level of NO. As a result, we suggest that the decreasing effect of melatonin on NO, which is a strong vasodilatator, may further increase the renal ischemia in this model. Thus, melatonin may have worsening rather than beneficial effects on myoglobinuric ARF.     

Successful Treatment of Six Patients with Neuroleptic Malignant Syndrome Associated with Myoglobulinemic Acute Renal Failure

Neuroleptic malignant syndrome is a rare but potentially lethal, rare reaction to neuroleptics which is characterized by altered levels of consciousness, extrapyramidal effects, autonomic instability, hyperthermia, and elevated serum creatine phosphokinase levels. The most serious complication of neuroleptic malignant syndrome is acute renal failure.

We investigated six cases of neuroleptic malignant syndrome associated with myoglobulinemic acute renal failure due to rhabdomyolysis and effect of hemodialysis or hemodiafiltration.

The patients were five males and one female with a mean age of 43.5 yr. All of the patients, who developed acute renal failure induced from rhabdomyolysis, had previously received butyrophenone (haloperidol), phenothiazine, benzamide, iminomide, benzisoxazole, antidepressants, and hypnotics (benzodiazepine and barbiturate) for the treatment of schizophrenia. The clinical manifestations of neuroleptic malignant syndrome were characterized by altered consciousness, muscle rigidity and weakness, fever, and excessive perspiration. The peak laboratory data were blood urea nitrogen 102 ± 26 (mean ± SD) mg/dL, serum creatinine 9.1 ± 2.1 mg/dL, serum creatine phosphokinase 229,720 ± 289,940 IU/L, and all of them developed oliguric acute renal failure. Dantrolene sodium administration was given to five cases and hemodialysis or hemodiafiltration was performed in all of them. The serum creatinine level after hemodialysis or hemodiafiltration was 1.4 ± 1.0 mg/dL. All patients were successfully cured of acute renal failure by hemodialysis or hemodiafiltration.

As a result, myoglobulinemic acute renal failure associated with neuroleptic malignant syndrome was successfully treated by hemodialysis or hemodiafiltration.