A case of hemodiafiltration dialysis preventing progression of acute kidney injury in a patient with hypermyoglobinemia in one kidney: a case report.

Abstract

Background: Rhabdomyolysis is a clinical syndrome resulting from skeletal muscle damage and the release of its breakdown products into the bloodstream. It can range from asymptomatic cases to severe conditions such as acute kidney injury. Although the release of myoglobin (molecular weight 17.2 kDa) into the blood is associated with the progression to acute kidney injury, there is no established method to prevent it. Here, we report a case of hypermyoglobinemia due to rhabdomyolysis caused by reperfusion injury following acute limb ischemia, where early renal replacement therapy was deemed effective.

Case presentation: The patient, a 73-year-old Japanese male, had a history of right nephrectomy due to trauma. At 2 years prior, he underwent bypass surgery connecting the subclavian artery to the bilateral femoral arteries to treat lower limb arteriosclerotic occlusive disease. In this case, he presented to another hospital with sudden right lower limb pain and was referred to our hospital with a diagnosis of acute occlusion of the right lower extremity artery. After emergency endovascular thrombectomy, hemodiafiltration was initiated on the second day due to rhabdomyolysis and hypermyoglobinemia. The patient developed compartment syndrome in the affected limb and underwent an emergency fasciotomy. Despite a further increase in myoglobin levels, his urine output remained stable, and creatinine levels stayed within the normal range. On the 6th day of admission, he was successfully weaned off hemodiafiltration. Following negative pressure wound treatment for compartment syndrome, a skin graft was performed, and the wound was closed. The patient was transferred for rehabilitation on the 35th day.

Conclusion: This case illustrates that early initiation of blood purification therapy can prevent the progression of acute kidney injury triggered by hypermyoglobinemia in rhabdomyolysis. Early intervention with intermittent hemodiafiltration may effectively prevent renal failure in such cases.