Acute kidney injury due to severe rhabdomyolysis with elevated serum CK level treated successfully with HDF/HD

Abstract

Background: In rhabdomyolysis, there is a significant relationship between the development of an acute kidney injury (AKI) and serum creatine phosphokinase (CK) levels. It has been reported that blood purification therapy such as hemodialysis (HD), hemodiafiltration dialysis (HDF), and plasma exchange is useful in patients with severe renal dysfunction. However, the selection criteria for these blood purification therapies remains unclear. Case report: A 73-year-old man with a history of schizophrenia and diabetes mellitus was brought to the emergency room with generalized weakness. The serum CK and creatine (Cr) were elevated to 283,500 U/L and 2.53 mg/dL, respectively. He was admitted with a diagnosis of rhabdomyolysis and AKI. Although intravenous fluids and diuretics were started, serum Cr increased to 7.11 mg/dL on the third day and the patient became anuric. Therefore, HDF with medium cut-off membranes was started on the fourth day and was performed six times until the 14th day. On the 15th day, serum CK was 90 U/L and rhabdomyolysis had resolved. On the 16th day, a switch from HDF to HD was made and HD therapy was completed on the 32nd day. Conclusion: In a patient who had AKI and rhabdomyolysis with marked serum CK elevation, use of HDF with medium cut-off membranes in the beginning followed by a switch to HD could result in improvement.