Abstract
A 52-year-old diabetic man was admitted with muscular weakness and oliguria. For two years before admission, he had been abusing several over-the-counter analgesics because of continuous and severe leg pain. On admission, there was severe generalized edema and severe muscle weakness. Laboratory tests gave these results: BUN, 119mg/dl; serum creatinine, 15.6mg/dl; serum potassium, 4.9mEq/l; CPK, 7, 726mIU/ml; urinary myoglobin>1, 000ng/ml. The diagnosis was myoglobinuric acute renal failuer. The patient was treated by IPD for the first 6 days after admission, but improvement was insufficient, so the treatment was changed to CAPD on the 7th hospital day. Soon after CAPD was started, the urine volume increased, and urinary myoglobin decreased to 200ng/ml. The findings from renal function tests and the levels of enzymes that escaped from striated muscle cells in the blood also improved. On the 29th day of CAPD, urinary myoglobin disappeared, the level of escaped enzymes became normal, and renal function test results were almost normal.
With the improvement in renal function, the number of times new CAPD fluid was used could be decreased with no impairment of the clinical condition. CAPD was stopped on the 44th day. At discharge from the hospital, the patient had normal muscle power and normal ability to move. BUN was 22.5mg/dl, serum creatinine, 1.7mg/dl, and creatinine clearance, 62.9ml/min. During the CAPD treatment, control of the blood sugar level was good, and neither peritonitis nor decrease in the serum protein level occurred.
In CAPD, compared with conventional hemodialysis, removal of medium-or large-molecule solutes is more effective, if examined by the week rather than by the hour. Also, the patient is free from the disequilibrium syndrome and from the restrant of being connected to instruments. The risk of bleeding is low because anticoagulants are not used. In the treatment of myoglobinuric acute renal failure, provided the disorder is not very catabolic in nature (as was the case here), we think CAPD would be a better method for treatment than hemodialysis. Removal of myoglobin and medium-molecular uremic toxins, which are neurotoxic, is more likely, and rehabilitation is easier. Further, CAPD is simpler, and more suitable for long-term treatment than IPD. CAPD seems a promising method for treating myogrobinuric acte renal failure.
