Levofloxacin and rhabdomyolysis in a renal transplant patient.

Rhabdomyolysis can lead to fatal hyperkalaemia, acute renalfailure and compartment syndromes in renal transplant patients.The most common cause for rhabdomyolysis in these patients isa drug interaction between statins and ciclosporin A [1]. Statinsare known to be myotoxic [2], and their serum levels can beelevated with the concomitant use of ciclosporin A, as the metabolismof both drugs is dependent     

Fever with acute renal failure due to body massage-induced rhabdomyolysis.

Sir, Body massage, known as complementary and alternative medicine,is very popular in the world [1,2]. [It is considered a relativelysafe therapy for the senior population that attempts to relievepain or improve quality of life.] However, in one incident,an 88-year-old man developed rhabdomyolysis in the aftermath     

Transient renal dysfunction due to rhabdomyolysis after robot-assisted radical prostatectomy

International Urology and Nephrology - The aim of the present study was to investigate whether renal dysfunction following rhabdomyolysis occurs after robot-assisted radical prostatectomy (RARP),...     

Ischemic rhabdomyolysis and acute renal failure

Rhabdomyolysis is a clinical syndrome characterized by the breakdown and later necrosis of skeletal muscle, leading to the release of various intracellular components into the blood stream. The clinical expression of rhabdomyolysis ranges from asymptomatic to severe forms involving multiorgan failure with electrolyte imbalance, respiratory distress syndrome, acute renal failure and disseminated intravascular coagulation. Diagnosis is based on a finding of elevated serum levels of components that are normally found within the muscle cell, chiefly muscle enzymes and myoglobin. Acute kidney failure, one of the main consequences of rhabdomyolysis, occurs in 4% to 33% of cases. Treatment requires prompt volume replacement with crystalloids. In spite of successful resuscitation and prophylaxis against myoglobulin-induced renal failure, 1 out of every 3 patients develops kidney damage and requires continuous replacement therapy.     

Non-traumatic rhabdomyolysis with acute renal failure

A clinical profile of non-traumatic rhabdomyolysis with acute renal failure is presented. Myoglobinuric renal failure is treatable and hence a high index of suspicion is warranted in the etiologies discussed.     

Postoperative acute renal failure secondary to rhabdomyolysis from exaggerated lithotomy position.

Perioperative renal dysfunction is a common problem following urogenital surgery. The most common causes of renal failure include ischemic or nephrotoxic acute tubular necrosis, renal vascular injury, and urinary tract obstruction. This case conference describes a patient who developed acute renal failure, secondary to rhabdomyolysis after a 7-hour urologic surgical procedure in an exaggerated lithotomy position. Early diagnosis and aggressive treatment are essential to prevent or limit the severity of acute renal failure. A review of the literature and pathophysiology of acute renal failure secondary to rhabdomyolysis is included.     

Possible cocaine-induced acute renal failure without rhabdomyolysis

Cocaine-induced acute renal failure has been reported in association with rhabdomyolysis. We describe a case of a young African American male who developed acute renal failure, which possibly occurred after inhalation of cocaine without concomitant rhabdomyolysis. His renal function recovered with supportive hydration. The most likely mechanism was intense vasoconstriction. Clinicians need to be mindful of this unique feature of cocaine intoxication.     

Itraconazole-induced rhabdomyolysis and acute renal failure in a heart transplant recipient treated with simvastatin and cyclosporine

BACKGROUND: Statins are widely used to decrease cholesterol and improve morbidity and mortality associated with coronary artery disease. Myopathy constitutes a rare but potentially life-threatening adverse reaction, which is related to plasma HMG-CoA reductase inhibitory activity. Therefore, the incidence of rhabdomyolysis increases dramatically when statins are co-administered with drugs that inhibit their hepatic transformation, such as cyclosporine or azoles. METHODS AND RESULTS: We present a case of severe rhabdomyolysis and acute renal failure induced by itraconazole in a heart transplant recipient chronically treated with cyclosporine and simvastatin. The literature with regard to the pathogenetic mechanisms and the clinical implications are reviewed. CONCLUSIONS: To avoid severe myopathy, cyclosporine levels should be monitored sooner than weekly intervals and statins should be discontinued or their dosage should be reduced, as long as azoles need to be prescribed in transplant recipients. Rhabdomyolysis and acute renal insufficiency should be promptly recognized and aggressively treated.     

Recurrent rhabdomyolysis and mild acute renal failure associated with acute Brucella infection.

Sir, Various infectious agents have been reported to cause rhabdomyolysis[1–5]. We present a case of acute Brucella infection,complicated with recurrent rhabdomyolysis and mild renal failure. A 39-year old man was admitted to hospital because of muscularpain and dark urine. Ciprofloxacine was begun 1 day before hisreferral with the possible diagnosis of urinary infection. Hereported consumption of unpasteurized milk     

Endothelial dysfunction in renal transplant recipients

Endothelial dysfunction and damage are systemic processes that are recognised to play a central role in the pathogenesis of hypertension and atherosclerotic cardiovascular disease. Renal failure is associated with impaired endothelium dependent vasodilatation that is partly a consequence of increased circulating levels of asymmetric dimethyl arginine. Endothelial dysfunction persists, although it is improved, after renal transplantation. Statins appear to improve endothelial dysfunction, as does withdrawal of calcineurin inhibitors, although there is no evidence that these strategies improve patient or graft survival. The situation in transplant recipients is complicated by the fact that endothelial dysfunction (within the graft vasculature) may be a separate process contributing to chronic allograft nephropathy and to circulating levels of endothelial cells and their components, thus limiting the utility of circulating markers of endothelial damage in this population.     

Severe rhabdomyolysis and acute renal failure due to multiple wasp stings

Sir, Rhabdomyolysis has been implicated as the cause of acute renalfailure in 5–7% of cases [1]. Many cases of rhabdomyolysis-associatedacute renal failure have been published, but those due to beeor wasp stings are quite rare [2–4], and are