Objective: To describe patients presenting with acute kidney injury after rhabdomyolysis at a\ntertiary renal care center in Pakistan. Patients and Methods: An observational cohort of patients\nidentified as having acute kidney injury (AKI) with rhabdomyolysis, which was diagnosed by rise\nin creatinine phosphokinase (CK) and lactate dehydrogenase (LDH) more than 4 times the reference\nrange whereas AKI was defined according to RIFLE criteria. On ultrasonography, all patients\nhad normal size non obstructed kidneys, and no other co morbid. Results: Between January 1990\nto December 2014, 334 patients with rhabdomyolysis and AKI registered to this hospital. Mean age\nwas 28.22 �± 11.22 years with M:F ratio of 3.33:1. Mean values of CK and LDH were 597,749.790 �±\n180,461.360 and 4077.026 �± 5050.704 U/L with reference range of 26 - 174 U/L and 91 - 180 U/L\nrespectively. We divided the study population into 4 groups over timeline. Rhabdomyolysis etiology\nwas divided in 3 groups; 1) traumatic, 2) non-traumatic exertional, and 3) non-traumatic\nnon-exertional. In the last group, which spans from 2010-2014, we treated many cases with toxic\nrhabdomyolysis and main toxin was paraphenylenediamine (PPD). The other causes showed more\nor less same prevalence over two and a half decade, except non-traymatic exertional which has\ndecreased during last 5 years without any explainable cause. Renal replacement therapy (RRT)\nwas required on arrival in 94% cases. Complete renal recovery was observed in 70%, while 15.86%\ndied and 10% were lost during recovery phase. A small number 2.69% left against medical advice\nduring acute phase of illness and 0.8% developed chronic kidney disease (CKD). Conclusion: The\ncommon clinical conditions found associated with rhabdomyolysis and AKI includes trauma, immobilization,\nsepsis, overexertion, and drugs and toxins. In recent years, we have seen many\nyoung patients with PPD poisoning; we have found good renal recovery in patients who survived\ninitial 2 - 3 weeks.
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