The effect of multiple trauma with rhabdomyolysis-induced acute kidney injury on the functional state of main body systems

Abstract

Background. Traumatic injuries often lead to rhabdomyolysis, the destruction of muscle tissue, which causes leakage of the intracellular contents of myocytes into the bloodstream. The most common systemic complication of rhabdomyolysis is acute kidney injury (AKI). It occurs with a frequency of 10 to 55 % and is associated with a poor prognosis, especially with multiple organ failure. The aim of our work was to investigate the impact of multiple trauma complicated by rhabdomyolysis and AKI on the state of the body’s main systems. Materials and methods. We examined 96 victims with multiple trauma complicated by rhabdomyolysis and AKI. Upon admission, we examined the frequency of vasopressor support, rate of diuresis, indicators of the blood count, biochemistry (hepatic, renal complex, electrolytes, creatine kinase, myoglobin), coagulogram, acid-base and gas composition of blood. Results. Severe multiple trauma caused a massive rhabdomyolysis with an increase in creatine kinase to 7058.3 ± 2726.2 units/l, myoglobin to 1433.1 ± 121.9 μg/l. The mean empirical blood loss volume was 2762.5 ± 363.4 mL, leading to posthemorrhagic anemia and thrombocytopenia. 56.3 % of victims needed vasopressor support. Stress hyperglycemia up to 9.2 ± 1.7 mmol/l was observed. Liver dysfunction manifested by a decrease in total protein to 45.3 ± 2.3 g/l, albumin to 26.9 ± 1.5 g/l, which created a risk of interstitial edema. A significant cytolytic syndrome was formed with an increase in alanine aminotransferase to 466.5 ± 141.4 U/l, aspartate aminotransferase to 822.9 ± 187.9 U/l. Moderate hypocoagulation was observed with a decrease in the prothrombin index to 74.6 ± 4.3 % and an increase in the international normalized ratio to 1.4 ± 0.1; activated partial thromboplastin time and fibrinogen level remained within normal limits. The inflammatory reaction manifested by leukocytosis up to (15.3 ± 1.3) × 109/l. AKI was accompanied by an increase in creatinine to 402.1 ± ± 58.6 μmol/l, urea to 19.9 ± 3.0 mmol/l. Diuresis on the first day after admission averaged 0.47 ± 0.08 ml/kg/h. Hyperkalemia was observed in 47.2 % of victims: in 26.5 % of cases, potassium level was from 5.5 to 6.5 mmol/l, in 13.2 %, from 6.5 to 7.5 mmol/l, in 7.5 %, more than 7.5 mmol/l. These disorders were accompanied by subcompensated mixed acidosis. Conclusions. Multiple trauma complicated by rhabdomyolysis and acute kidney injury forms multiple organ failure with a high frequency of vasopressors need, post-hemorrhagic anemia, stress hyperglycemia, impairment of protein synthetic, pigment, enzymatic functions of the liver, coagulopathy, inflammatory syndrome, mixed acidosis and kidney damage per se, which manifested by oliguria, hyperazotemia and hyperkalemia.