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Kidney Week

Abstract: PO0044

Severe Exertional Rhabdomyolysis with AKI Associated with Sickle Cell Trait

Session Information

Category: Trainee Case Report

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Zhang, Zi R., Rush University Medical Center, Chicago, Illinois, United States
  • Qian, Edward, Rush University Medical Center, Chicago, Illinois, United States
  • Rodby, Roger A., Rush University Medical Center, Chicago, Illinois, United States
Introduction

Exertional rhabdomyolysis (ER) is a pathological breakdown of muscle cells which can result in acute kidney injury (AKI) from multiple mechanisms including tubular toxicity from heme pigment, cast formation, and volume depletion. ER has a host of etiologies including drugs, ingestions, infections, electrolyte abnormalities, trauma, venom, and metabolic disorders. Sickle Cell Trait (SCT), a generally asymptomatic condition, has been rarely associated with ER. We present a case of severe ER with AKI in a previously healthy patient who was determined to have SCT as the only risk factor.

Case Description

A 39 y/o previously healthy black police recruit on no medications presented with myalgias and dyspnea following a routine training regimen. He was found to have diffuse tenderness and weakness of arms and legs. Initial labs showed serum creatinine (sCr) 2.0 mg/dL, Na 148 mmol/L, CO2 <5 mmol/L, Creatine Kinase (CK) 1,516 U/L. A peripheral blood smear showed few sickle cells. His urine was dark tea-colored and on urinalysis had large blood and minimal RBCs. Illicit drug panel, autoimmune studies, myophosphorylase deficiency, and myositis panel including anti-SSA, anti-PM/Scl, and anti-U1RNP were normal or negative. A hemoglobin electrophoresis demonstrated 35% Hgb S and 62% Hgb A consistent with SCT. He was oliguric and was started on renal replacement therapy (RRT) with CVVH initially and then iHD. His CK and sCr peaked at 565,000 U/L and 13.9 mg/dL respectively (figure 1). He required 18 days of RRT. His sCr after discharge improved to 1.4 mg/dL.

Discussion

SCT is normally a relatively benign condition as there is enough normal Hgb to prevent significant sickling. However, increased O2 demand with exertion may promote clinically significant sickling and lead to vaso-occlusion and hypoxic muscle injury. ER in SCT is rare and unpredictable and therefore specific recommendations for re-introduction of exercise are not available. However, guidelines for Exercise Collapse Associated with Sickle Cell Trait (ECAST) can be used to guide long term patient management.

Fig. 1. sCr and CK since admission.