Rhabdomyolysis (RML) as an etiological factor causing acute kidney injury (AKI) is sparsely reported in the literature.

To study the incidence of RML after surgical repair of an ascending aortic dissection (AAD) and to correlate with the outcome, especially regarding renal function. To pinpoint the perioperative risk factors associated with the development of RML and adverse renal outcomes after aortic dissection repair.

Retrospective single-center cohort study conducted in a tertiary cardiac center. We included all patients who underwent AAD repair from 2011-2017. Post-operative RML workup is part of the institutional protocol; studied patients were divided into two groups: Group 1 with RML (creatine kinase above cut-off levels 2500 U/L) and Group 2 without RML. The potential determinants of RML and impact on patient outcome, especially postoperative renal function, were studied. Other outcome parameters studied were markers of cardiac injury, length of ventilation, length of stay in the intensive care unit), and length of hospitalization.

Out of 33 patients studied, 21 patients (64%) developed RML (Group RML), and 12 did not (Group non-RML). Demographic and intraoperative factors, notably body mass index, duration of surgery, and cardiopulmonary bypass, had no significant impact on the incidence of RML. Preoperative visceral/peripheral malperfusion, though not statistically significant, was higher in the RML group. A significantly higher incidence of renal complications, including de novo postoperative dialysis, was noticed in the RML group. Other morbidity parameters were also higher in the RML group. There was a significantly higher incidence of AKI in the RML group (90%) than in the non-RML group (25%). All four patients who required de novo dialysis belonged to the RML group. The peak troponin levels were significantly higher in the RML group.

In this study, we noticed a high incidence of RML after aortic dissection surgery, coupled with an adverse renal outcome and the need for post-operative dialysis. Prompt recognition and management of RML might improve the renal outcome. Further large-scale prospective trials are warranted to investigate the predisposing factors and influence of RML on major morbidity and mortality outcomes.

• Rhabdomyolysis
• Ascending aortic dissection surgery
• Acute kidney injury
• Postoperative renal outcome
• Open heart surgery
• Type A aortic dissection

• IR
• Lung
• Quercetin
• SIRT1
• VEGF
• iNOS

• Animals
• Quercetin/pharmacology
• Quercetin/therapeutic use
• Reperfusion Injury/metabolism
• Reperfusion Injury/prevention & control
• Reperfusion Injury/pathology
• Male
• Rats
• Muscle, Skeletal/drug effects
• Muscle, Skeletal/pathology
• Muscle, Skeletal/metabolism
• Lung Injury/etiology
• Lung Injury/prevention & control
• Lung Injury/pathology
• Lung Injury/metabolism
• Sirtuin 1/metabolism
• NF-kappa B/metabolism
• Cytokines/metabolism
• Vascular Endothelial Growth Factor A/metabolism
• Vascular Endothelial Growth Factor A/genetics
• Lung/pathology
• Lung/metabolism
• Lung/drug effects
• Antioxidants/pharmacology
• Malondialdehyde/metabolism

• anesthesia
• bariatric
• complication
• obesity
• rhabdomyolysis
• surgery

• Rhabdomyolysis
• blood purification
• cytosorb®
• kidney recovery
• kidney replacement therapy
• myoglobin

• Adult
• Humans
• Middle Aged
• Propensity Score
• Critical Illness/therapy
• Myoglobin
• Prospective Studies
• Kidney
• Rhabdomyolysis/complications

Takotsubo syndrome (TTS) is a type of non-ischemic cardiomyopathy characterized by an acute reversible left ventricular dysfunction with typical apical ballooning, usually with subsequent complete recovery. Early diagnosis and prompt treatment are of great essence. Herein, we described a case of TTS of a patient who was scheduled initially for laparoscopic endometrial cancer staging. The 69-year-old woman presented with cardiogenic shock induced by the severe anaphylactic reaction to the antibiotics during anesthesia induction. Cardiopulmonary resuscitation (CPR) was implemented while several boluses of 1 mg epinephrine were injected. After the return of spontaneous circulation, a large number of orange peel-like rash appeared on the head, face, neck, and trunk of the patient. Transesophageal echocardiography (TEE) revealed diffused decreased left ventricular systolic function. Therefore, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pump (IABP) were applied in the intensive care unit. Biomarkers like cardiac troponin I (cTnI) subsequently decreased with improved cardiac insufficiency. Finally, the patient was discharged in good condition. This case demonstrated that TTS could be secondary to severe anaphylactic shock and exogenous catecholamines. With the consideration of the reversible condition and predictable recovery of TTS, early vigilance and advanced life support devices should be necessary.

• Peking Union Medical College
• Chinese Academy of Medical Sciences
• Beijing Municipal Commission of Education

The correlation between rhabdomyolysis and postoperative acute kidney injury has been reported in several surgical procedures. As a good predictor of rhabdomyolysis-related acute kidney injury, an elevated serum myoglobin level was often observed after total aortic arch replacement combined with frozen elephant trunk implantation. However, the correlation between serum myoglobin and acute kidney injury in such patients had not been established.

Totally 398 stanford type A aortic dissection patients who underwent total aortic arch replacement combined with frozen elephant trunk implantation were enrolled in this retrospective study. The correlations between serum myoglobin and acute kidney injury as well as the 30-day mortality were assessed.

Overall, 268(67.3%) patients had acute kidney injury (KDIGO stage 1 or higher) and 75(18.8%) had severe acute kidney injury (KDIGO stage 2&3). Patients who developed acute kidney injury had higher level of perioperative serum myoglobin than patients without acute kidney injury. After adjusting for known acute kidney injury risk factors, logarithmically transformed preoperative serum myoglobin [OR = 1.58 (95% CI, 1.26–1.95), P < 0.001] and postoperative day 1 serum myoglobin [OR = 3.47 (95%CI, 2.27–5.29), P < 0.001] were associated with severe acute kidney injury. These correlation persisted after adjustment for decline in filtration via change in serum creatinine (ΔCr) and biomarkers of cardiac and kidney injury, including N-terminal prohormone of brain natriuretic peptide, cardiac troponin I, creatine kinase-MB, serum creatinine and Cystatin C. Compared with the clinical model, sMb considerably improved the risk discrimination and reclassification for AKI.

For stanford type A aortic dissection patients underwent total aortic arch replacement with frozen elephant trunk implantation, serum myoglobin can improve postoperative acute kidney injury risk classification. Rhabdomyolysis may be an important supplement to the existing knowledge on the mechanism of acute kidney injury.

• acute kidney injury
• aortic dissection
• myoglobin
• rhabdomyolysis
• total aortic arch replacement

Rhabdomyolysis is a clinical condition characterized by destruction of skeletal muscle with release of intracellular contents into the bloodstream. Intracellular contents released include electrolytes, enzymes, and myoglobin, resulting in systemic complications. Muscle necrosis is the common factor for traumatic and non-traumatic rhabdomyolysis. The systemic impact of rhabdomyolysis ranges from asymptomatic elevations in bloodstream muscle enzymes to life-threatening acute kidney injury and electrolyte abnormalities. The purpose of this clinical consensus statement is to review the present-day diagnosis, management, and prognosis of patients who develop rhabdomyolysis.

• KL2 TR001421 NCATS NIH HHS
• UL1 TR001863 NCATS NIH HHS

• Bicarbonate
• Mannitol
• Practice management guidelines
• Rhabdomyolysis

• Health services utilization
• Opioid overdose
• Opioid treatment

• ferritin
• heme oxygenase-1
• hemolysis
• kidney disease
• rhabdomyolysis

• Animals
• Ferritins/metabolism
• Heme/metabolism
• Heme/urine
• Heme Oxygenase-1/metabolism
• Hemoglobinuria/metabolism
• Hemoglobinuria/pathology
• Humans
• Kidney Diseases/metabolism
• Kidney Diseases/pathology
• Rhabdomyolysis/metabolism
• Rhabdomyolysis/pathology

• K08 HL140294 NHLBI NIH HHS
• K08HL140294 NHLBI NIH HHS

• Acute kidney injury
• Blood purification
• Cytosorb ®
• Myoglobin
• Rhabdomyolysis