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Kidney Week

Abstract: SA-PO099

Multifactorial Rhabdomyolysis in an HIV Patient: Management of AKI

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Gupta, Uma Datta, Interfaith Medical Center, Brooklyn, New York, United States
  • Nguyen, Thi My Nguyet, Interfaith Medical Center, Brooklyn, New York, United States
  • Subedi, Saphal Nath, Interfaith Medical Center, Brooklyn, New York, United States
Introduction

Rhabdomyolysis is common in HIV patients with drug abuse history, however literature is scarce regarding management. In our multifactorial rhabdomyolysis case, CK level is more than 100,000 with proteinuria, which is a rare presentation. The findings in our case highlight the importance of individualized management approach based on the underlying etiologies and the patient's clinical status.

Case Description

In our case, a 32-year-old male with unknown past medical history presented to the emergency department with altered mental status. He was diagnosed with Strep Pneumonia, subsequently with HIV, HCV, polysubstance abuse (amphetamine, cocaine, and opiates) and later developed rhabdomyolysis with nephrotic range proteinuria. The patient received conservative treatment with 10-20 ml/kg of isotonic saline with 1 Liter of glucose 5% with 100 mmol of bicarbonate bolus. The goal was to maintain Urine output of 1 to 2 ml/kg/hour. Notably, there was a progressive improvement in the proteinuria, (from 4.5 grams per day to 1.45 grams per day).Considering the decline in proteinuria and the restoration of renal function, a renal biopsy was not planned at this stage. To support the patient's nutritional needs, a high protein diet was administered via a nasogastric tube, targeting a dosage of 1.6-1.8 grams per kilogram of body weight.

Discussion

This HIV patient with rhabdomyolysis and nephrotic range proteinuria who developed AKI due to multifactorial causes was treated with various management strategies- including pharmacological interventions targeting the specific etiologies, fluid therapy for volume resuscitation and electrolyte balance, and nutritional support. The efficacy of the conservative interventions was evaluated by improvement in renal function and reduction in proteinuria.

Trend of CK level
Day 13656Day 576889Day 1122530
Day 2>100000Day 836445Day 155414

Creatine Kinase Level trend

Protein Creatinine Ratio