Rhabdomyolysis and Acute Kidney Damage developed during Periodic Disease: Report of a Case of Acute Polymyositis complicated by Myorenal Syndrome
Mane Sargsyan1,2,3, Vardan Ghukasyan1,2, Armine Khechoyan2, Svetlana Hayrapetyan1,2,3, Sonya Palangyan2, Tatyana Alaverdyan2,4
1 Department of Nephrology and Pulmonology, Heratsi Yerevan State Medical University, Yerevan, Armenia
2 Department of Nephrology, Surb Grigor Lusavorich Medical Center, Yerevan, Armenia
3 Department of Hemodialysis, Surb Grigor Lusavorich Medical Center, Yerevan, Armenia
4 Department of Therapy, Avdalbekyan National Institute of Health, Yerevan, Armenia
ABSTRACT
Rhabdomyolysis is a clinical syndrome characterized by myalgia, muscle weakness and the formation of reddish-brown urine. The development of the syndrome is based on peculiar morphological changes in muscle tissue, which are expressed by destruction of muscle tissue at the cellular level and impaired muscle function. The consequence of this is the entry of intracellular components, especially creatine phosphokinase and myoglobin, into the bloodstream. The latters are filtered by the tubules of the kidneys and, passing through the tubular apparatus, damage epithelial cells, leading to the development of necrosis. Acute myorenal syndrome with advanced rhabdomyolysis leads to acute renal failure in 75% of cases. According to the etiological factor, rhabdomyolysis can be traumatic (physical overload) and atraumatic (drug). Among the latter, the leading role belongs to medicines. This is especially true for colchicine, which is known to be widely used in periodic inflammatory diseases, both to reduce the frequency of attacks and to prevent the development of amyloidosis. The peculiarity of the presented case is that a 30-year-old young male suffering from familial Mediterranean fever, constantly taking colchicine 2.0 mg, upon moderate physical exertion experienced severe pain in the lumbar region and femoral muscles, with a picture of acute polymyositis and further development of rhabdomyolysis and acute renal failure.
Keywords: familial Mediterranean fever, rhabdomyolysis, colchicine, creatine kinase, myoglobin, kidney damage